Clinical Associate

Benefits

Qualifications

• •Education: High School Diploma, G.E.D., or equivalent abilities and skills required
• •Certified Pharmacy Technician required
• •Knowledge of Microsoft Windows, including word processing and spreadsheet applications
• •Good computer skills in general with the ability to learn new software programs and applications
• •Strong organizational skills
• •Ability to effectively communicate with internal and external clients
• •Ability to multi-task
• •Excellent analytical skills
• •ESSENTIAL FUNCTIONS (These duties must be performed with or without reasonable accommodation
• •Must be able to cope with the mental and emotional stress of the position
• •7 more items(s)

Responsibilities

• •Under general supervision, the Clinical Associate provides assistance to members, pharmacists, or physicians regarding prescription services and prior authorization activities in accordance with established policies and procedures, laws and regulations
• •Contact providers to gather clinical information and to discuss individual members' cases
• •Contact and confer with pharmacists and physicians regarding questions or irregularities on prescriptions
• •Processes authorizations including the input of new authorizations, refill of new authorizations, request of new authorizations and the review process of authorizations
• •Work directly with Customer Service Representatives as a resource for formulary and plan-related questions
• •Maintain current knowledge of plan specifications and requirements
• •Maintain current knowledge of drug therapies and drug reactions and interactions by reading professional literature, attending seminars and through professional affiliations
• •Work with clinical managers, Customer Service Manager, staff, and clients in developing and carrying out various clinical initiatives
• •Attend and participate in other programs, committees, meetings, and functions as required
• •Maintains regular attendance in accordance with established policies
• •Perform other job-related duties as assigned
• •Promptly report any allegations of impropriety to the Compliance Department
• •Comply with Maxor's Ethical Business Conduct policy and Maxor's Compliance Program
• •Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists
• •Complete required training, as assigned, within the established timeframes
• •12 more items(s)