Remote Clinical Review Pharmacist Job at Medical Review Institute of America, Remote

NVc4VjRCMkp5L0FkUE9DWlZoWHpzbHRYeGc9PQ==
  • Medical Review Institute of America
  • Remote

Job Description

Description



Who We Are – Motivated by Purpose. Powered by Clinical Expertise.

Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.

Excellence starts with our people.

WE OFFER

  • A competitive compensation package.
  • Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
  • Growth and training opportunities.
  • A team atmosphere with fun events and prizes scheduled throughout the year.

POSITION OVERVIEW

Our Clinical Review Pharmacist is responsible for performing clinical utilization management, peer review activities, and clinical quality management activities

Role:

  • To provide clinical direction, guidance, and support to the management team, staff, and all independent contracting clinician reviewers as indicated

Major Responsibilities or Assigned Duties:

  • Perform utilization management case reviews.
  • Maintain monthly productivity score per company standard.
  • Maintain annual quality score per company standard.
  • Train across all queues as requested by MRIoA leadership.
  • Complete all client specific training as requested by MRIoA leadership.
  • Maintain up-to-date records of case completion.
  • Consistently show willingness to take cases as requested.
  • Demonstrate respect in interactions across the company.
  • Consistently submit scheduling requests at least three months in advance. Consistently work scheduled hours.
  • Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company).
  • Respond appropriately and in a timely manner to licensing/CME requests from Chief Medical Officer and/or administrative team.
  • Actively participate in the MRIoA evaluation process (both company and individual).
  • Participate in all company meetings and committees as requested.
  • Complete other duties as requested or approved by the CEO and/or Chief Medical Officer

Requirements

Skills and Experience:  

  • Minimum of one year of experience working as a pharmacist or PGY 1 preferred
  • Experience working with commercial appeals preferred
  • Experience working for a health plan or pharmacy benefits manager preferred
  • Credentialed and privileged by the company’s credentialing committee
  • Thorough understanding of the company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standard
  • Willingness to obtain additional state licensure as required for the position

Education:

  • PharmD degree
  • Pharmacist license in good standing

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity Statement:

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



Drug-Free Workplace:

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only):

  • Sensitive Personal Info : MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
  • Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com. 

Jobicy JobID: 137151

Job Tags

Remote job, Full time, Work at office, Work from home,

Similar Jobs

Healthcare Support

Travel Dialysis Technician - $1,293 per week Job at Healthcare Support

 ...Healthcare Support is seeking a travel Dialysis Technician for a travel job in Conway, New Hampshire. Job Description & Requirements ~ Specialty: Dialysis Technician ~ Discipline: Allied Health Professional ~ Start Date: ASAP ~ Duration: 13 weeks ~36 hours... 

Ramona Rehabilitation & Post Acute Care Center

Housekeeping/Laundry Supervisor Job at Ramona Rehabilitation & Post Acute Care Center

 ...Housekeeping & Laundry Supervisor Skilled Nursing Facility We are seeking a reliable and organized Housekeeping & Laundry Supervisor to join our team at Ramona Rehabilitation & Post-Acute Care Center . This role oversees daily housekeeping and laundry operations... 

PM2CM

Contract Administrator II Job at PM2CM

 ...As part of the Project Management Office (PMO) Contracts Team, responsibilities may include any of the following: ~ Coordination...  ...through award including direct responsibility for all administrative functions (i.e preparing procurement documents, addenda, evaluation... 

Kaiser Permanente

Endoscopy RN - Ambulatory Care & Conscious Sedation Job at Kaiser Permanente

 ...care to patients and coordinate their health services. The ideal candidate will have an Associate's degree in Nursing, a Washington RN license, and certifications in BLS and ACLS. Strong communication, problem-solving, and leadership skills are essential for this role... 

Everglades Equipment Group

Accounting Manager Job at Everglades Equipment Group

 ...Financial Officer (CFO) Supervises: Accounts Payable, Accounts Receivable, Payroll, Accounting Staff Position Overview The Accounting Manager is responsible for overseeing the daily accounting operations of the dealership in accordance with company policies and Generally...