Job Information

KPH Healthcare Services, Inc. Clinical Services Specialist in Gouverneur, New York

Overview

Scope of Responsibilities: Assist with the day-to-day operations of the Clinical Pharmacist and clinical department of ProAct. Works under direct supervision and follows standard procedures to accomplish assigned tasks.

Job Summary: Responsibility for overseeing the prior authorization process, initial prior authorization review, and assisting with tasks and goals that meet the clinical needs of ProAct clients and members.

Responsibilities

Job Duties:

  • Oversee the prior authorization process to maintain efficiency and timeliness.

  • Review prior authorization requests based on currently-available guidelines

  • Provide Help Desk support, where appropriate, for questions regarding overrides or system edits

  • Responsible for working with Implementation Department for loading prior authorization data for new clients when appropriate

  • Assist in preparation of member mailings for various cost containment/clinical programs.

  • Assist both members and Noble Health Services in finding most cost-effective channels for specialty medications

  • Maintain records of all prior authorizations completed by ProAct

  • Providing reports on monthly basis

  • Providing data for Accounting Department for invoicing

  • Assist in the development and updating of formulary documents

  • Responsible for completing all mandatory and regulatory training programs

  • Assist with the day-to-day operations of the ProAct Help Desk

  • Perform other duties as assigned

Qualifications

Attendance Requirements:

  • Must be available, and on-time for scheduled work shifts

Educational Requirements:

  • Minimum: High School Diploma (or currently enrolled) or GED

  • Preferred: AS Degree or Higher

Required:

  • National Pharmacy Technician Certification through PTCB, or other accrediting agency, in good standing.

Experience:

  • Preferred hospital or retail pharmacy experience preferred

Special Conditions of Employment:

  • Drug test

  • Initial and continuous exclusion and sanction/disciplinary monitoring

  • Any and all additional eligibility requirements based on the specific position

Required Training:

  • HIPPA Privacy Course and CE Mastery Exam

  • HIPPA Security Course and CE Mastery Exam

Job Skills Required:

  • Strong Communication Skills: Must be able to effectively communicate both on the phone and in group setting

  • Strong Organizational Skills

  • Proficient in using Microsoft Excel, Word, and Access

  • Must be able to work independently

Behavioral Traits :

  • Cooperation: Must work harmoniously and effectively with fellow employees, supervisors and other in contact with

  • Initiative: Must work within supervision guidelines and assume additional responsibilities

  • Flexibility: Must be willing to work variable work schedules, assist others as requested and available, and be willing to perform all assigned work

  • Adaptability: Must respond to new situations in a positive way, accept change, support new ideas, master new routines and grasp explanations, apply current knowledge in new environments and experiences

  • Involvement: Must enjoy the demands of the job and work with interest and enthusiasm

  • Customer Service: Must provide appropriate customer service (for Kinney customers, fellow employees and business partners), listen attentively to their needs and respond appropriately

  • Safety: Must take care of equipment and employ good safety habits

  • Leadership: Must gain acceptance of ideas and accomplish goals through subordinates, peers and teams

Compensation:

$17.76 - 19.31 an hour

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.

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Job Locations US-NY-East Syracuse, NY | US-NY-Gouverneur

Posted Date 2 weeks ago (2/12/2024 3:24 PM)

Requisition ID 2024-12202

# of Openings 1

Category Healthcare

Location : Location US-NY-East Syracuse, NY