Note: The job is a remote job and is open to candidates in USA. Integrated Resources, Inc. is seeking a Clinical Operations Consultant to support prior authorization operations and administrative processes. The role serves as a prior authorization system subject matter expert, supporting operational and administrative teams and coordinating with internal and external departments to ensure effective program processing and implementation.
Responsibilities
- 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
Skills
- 3+ years of Pharmacy Benefit Management (PBM) prior authorization experience
- Bachelor's Degree in any related field
- Verifiable High School Diploma, GED, or equivalent
- 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
Company Overview
Company H1B Sponsorship