Specialty Review Pharmacist

Position Overview:

 MedOne is hiring a clinically focused pharmacist to lead specialty medication reviews, conduct consults, evaluate drug literature, and guide prior authorization decisions with precision and timeliness. 

About MedOne:

MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price.

What You'll Do:

• Evaluate, review and interpret clinical guideline criteria and appropriately utilize clinical knowledge and resources when rendering coverage determinations (approvals, part approvals, denials) with a focus on specialty medications  
• Perform and completes outbound clinical consult calls with physicians, healthcare providers and/or patients to as requested to answer inquiries regarding determinations 
• Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations that are outside clinical guideline criteria 
• Provide detailed and thorough documentation in prior authorization cases, appeals cases, and overrides 
• Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times 
• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements 
• Provide mentorship to the Clinical Review Technician team as required. 
• Assist Member Advocate and Account Management teams with patient or provider requests requiring pharmacist intervention. 

What You Will Bring to MedOne:

• Minimum of a Bachelor’s Degree in Pharmacy or PharmD with current unrestricted licensure as a pharmacist
• Proficient in Microsoft Office Suite and experience using clinical resources (Micromedex, Lexicomp, Clinical Pharmacology) 
• Ability to translate clinical information into a manner appropriate for both clinical and non-clinical audiences 
• High degree of emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution 
• Detail-oriented with a high degree of accuracy.  
• Strong interpersonal, written, and verbal communication skills. 
• Ability to work independently and manage time effectively. 
• Excellent customer service and teamwork skills  
• Must have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations (for remote employees) 
• Familiarity with data entry software or CRM systems (Microsoft Dynamics) is a plus. 

Why MedOne?

At MedOne, we believe that a healthy team is a happy team. We offer a collaborative work environment, competitive benefits, and opportunities for growth—all while helping to make a difference in people’s lives.

Our top core value is to prioritize your well-being. To support you in living this value, we offer:

• Competitive salary and bonuses that reward your performance.
• Comprehensive health, dental, and vision insurance + additional benefits
• 401(k) with company match to secure your future.
• Generous paid time off and holidays.
• Opportunities for professional growth and development.
• A vibrant and collaborative work culture.

Location: Offices in either Dubuque, IA, or Kansas City, MO, or the position can be remote within the United States.

Employment Type: Full-Time, Salaried

Reports to: Chief Pharmacy Officer

How to Apply: If you're enthusiastic about helping others and eager to join a dynamic team, we’d love to hear from you. Apply now and take the first step toward a rewarding career at MedOne! You can submit your application through our careers page.

MedOne is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Job Offers are contingent on passing a background check and drug screen.