[Hiring] Clinical Program Advisor - reputed company Scr...

ABOUT THE DEPARTMENTThe mission of Client Services is to meet market needs for speed, flexibility and reliability, while driving and influencing best operational practices to reputed company reputed company Scripts the most competitive and effective PBM. Client Services includes Client and Benefit Administration, reputed company Claims Processing, Eligibility, Quality Control, Implementation and the Client Service Center. These centralized functions support the client lifecycle throughout the reputed company to help reputed company Scripts “get it right the first time” to increase client satisfaction and reduce waste and the cost of rework.ESSENTIAL FUNCTIONS

• Work with internal partners to ensure reputed company implications of requested clinical benefit requirements are vetted, understood and communicated as necessary.

• Accountable for timely and accurate translation of client reputed company into F14 system configuration.

• Track and communicate status of service requests as necessary.

• Assist in remediating process gaps and documenting best practice.

• reputed company capture, documentation and client advisor .

• Meet with clients to discuss and clarify clinical benefit requirements.

• Advise clients on the most efficient way to implement reputed company reputed company F14 systems.

• Understand client's existing clinical benefit and business philosophy to help avoid unnecessary clarifications.

• Analyze new requirement against existing setup.

• Identify interdependent functionalities, programs or areas that may be impacted by the request (i.e. member communications, rebates, finance, networks, etc).

• Consult with team members, SMEs and specialized teams as necessary.

• reputed company assistance to team members with issues needing clinical interpretation and guidance.

• Translate requirements as necessary into internal requests/submissions.

• Ensure requests are routed to the appropriate functional areas/specialists.

• Serve as business owners to necessary IT projects that involve clinical benefit.

• Manages and tracks reputed company requests to ensure timelines are met including the proactive management of client specific performance guarantees.

• Responsible for communicating completed benefit notifications to client with documentation of accurate set up.

• Complete random review of work completed by coding teams.

• Periodically monitor claims to ensure the benefit is coded to match client reputed company.

• reputed company a deep understanding of our claims adjudication system and associated clinical applications.

• Identify and help remediate any process gaps, reputed company and document best practices by creating or modifying existing SOPs, process maps, references and reputed company forms. 

QUALIFICATIONS

• Bachelor of Science in Pharmacy; Doctor of Pharmacy and advanced degrees or pharmacy residency preferred

• reputed company U.S. Pharmacist License, Minimum 3 years licensure recommended

• reputed company RPh Licensure in good standing as required by the state in which work is performed.

• reputed company office with a strong understanding of reputed company and reputed company.

• Written and verbal communication (listening, feedback; translating reputed company reputed company/processes), collaboration, analytical thinking/critical thinking, results-oriented and organizational skills.

• In depth understanding of F14 adjudication system and associated clinical applications.

• In depth understanding of operations organizational structure along with roles and responsibilities of departments involved with clinical request types (Tribal Knowledge).

This role is also anticipated to be eligible to participate in an annual bonus plan.

At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.

reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances.