Clinical Reviewer - Pharmacist (Part-Time)

• Are you an experienced Clinical Reviewer - Pharmacist looking for a new challenge?
• Do you value care management and quality improvement?
• Are you motivated, energetic, and excited to become part of the Kepro team?

If so, you might be our next new team member!

Who we need:

The Clinical Reviewer reviews electronic prior authorization request based upon pre-established criteria and approves or denies request. Position will also be responsible for assisting call center employees with email questions, modifications, and provider inquiries as required. This is a part time position with expected coverage four (4) hours each weekday afternoon including some holidays as required.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career.

Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What you’ll do:

• Approves or denies prior authorization of medication according to guidelines and directions as defined by the client. Data enters information into the Kepro/Client database. Corrects errors, if needed.
• Assist customer service reps and pharmacy technicians with questions regarding approval or denial on medications. Researches issues and resolves the issue.
• Review appeals/requests for reconsideration according to guidelines and directions as defined by the client
• Handles and documents complaints related to clinical issues before escalating the issue to an account manager. Notifies management when necessary. May support more than one client.
• Provide supervisory guidance to team members.
• Provide / assist with training of other employees.
• Adheres to all company policies and procedures.
• Participate in fingerprinting and background screenings as required.
• Meet and/or exceed production, quality, attendance and adherence standards.
• Perform other duties as assigned

What you’ll need:

Required Qualifications

• Licensed Pharmacist holds an active and unrestrictive license in the State of operation.
• Minimum –Bachelor’s Degree in Pharmacy is required.
• Preferred – Doctorate of Pharmacy Degree (Desired, not required).

Knowledge, Skills, Abilities

• A combination of comprehensive therapeutic knowledge, problem-solving skills, and judgment is necessary.
• Ability to work cooperatively with others; comprehension of the current standards of pharmacy practice; and understanding of the challenges of professional pharmacy practice.
• Ability to master computer / software applications necessary for completing job tasks as required.
• Ability to manage workload and meet contractual deadlines.
• Ability to understand functionality of applications for processing of PA reviews (approvals and denials).
• Excellent verbal and communication skills.
• Excellent research and writing skills.

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Kepro Talent Acquisition Team

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.