Clinical Operations Consultant

Job Title: Clinical Operations Consultant
Job Location: Fully Remote
Job Duration: 6 Months

The Clinical Services Consultant fulfills the company purpose of helping people on their path to better health by driving quality execution of administrative support for Prior Authorization. The Clinical Services Consultant will be a Prior Authorization system Subject Matter Expert providing support for the Prior Authorization/Appeals Operational and Administrative teams. This position works closely with and fosters communications with internal and external departments including clinical development, product owners, CAS liaisons, Account Teams and Prior Authorization Operations to ensure a solid understanding of the programs being processed and implemented.
Daily Configuration & Document Management
Configure criteria documents and fax forms into the Prior Authorization system daily, ensuring accuracy and completeness.
Link workload to specific drug classes and clients.
Validate all configurations for compliance and operational standards.

In order to be successful in this role you will interact and collaborate with internal colleagues to identify opportunities to improve processes and drive efficiencies within the department as well as assist in leading meetings, creation and maintenance of work instructions, training, projects and activities related to PA systems. Consultants also work with a team of system trainers to provide consistent back end user support, assist in documentation and maintenance of user guides presentations and corrective action plans, provide system demos and help guide CAS users through the implementation process for Prior Authorization system tool.

Required Experience:
-3+ years of Pharmacy Benefit Management (PBM) prior authorization experience

Preferred Qualifications:
-Experience with PA system setup
-Experience with MS Excel, Word and PowerPoint
-Experience with CAS and/or MedHOK systems
-Experience with Prior Auth and Appeals activities
-Experience with previous project management.
-Strong attention to detail and commitment to high-quality work.

Education: Bachelor's Degree in any related field
Verifiable High School Diploma, GED, or equivalent