Physician Pharmacy & Utilization Advisor - MD
Location: Memphis Tennessee
Description: Sedgwick CMS is in need of Physician Pharmacy & Utilization Advisor - MD right now, this occupation will be placed in Tennessee. Further informations about this occupation opportunity kindly read the description below. Physician Pharmacy & Utilization Advisor
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Providing both satisfying and challenging work along with a highly ! professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, 'Claim Your Future.'
PRIMARY PURPOSE: To conduct physician advisor reviews on clinically complex pharmacy claims and other non-approved utilization review (UR) procedures utilizing evidence based criteria; to support the pharmacy team of nurses and claim examiners with training and implementation of medical best practices; and to provide support as necessary with presentations for product portfolio, service delivery, customer satisfa! ction, and renewal of managed care products.
ESSENTIAL FUN! CTIONS and RESPONSIBILITIES
Responsible for conducting physician reviews on pharmacy cases where the nurse is seeking treatment plan changes or blocking of medications.
Responsible for generating phone calls to treating physicians to enter into a motivational conversation to create the case for change of treatment plans by providing evidence based information and risks.
Responsible for documenting recommendations with One Team using the appropriate format referencing evidence based criteria within the required time frame.
Responsible for oversight of the appeal and review process including making a recommendation of specialty and supplier for second level appeal.
Develops training materials in conjunction with clinical trainer to meet training needs.
Interfaces and provides guidance and leadership to UR and pharmacy as well as team leads where appropriate.
Works with clinical leadership team to establish policy and p! rocedures to assure compliance to best practices, service standards, state regulations, and client service requirements and assure efficient, cost effective, quality program delivery for medical and disability management.
Coordinates and evaluates the service delivery between the company, partners, and vendors. ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as required.
Supports the organization's quality program(s).
Travels as required. SUPERVISORY RESPONSIBILITIES
Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
Provides support, guidance, leadership and motivation to promote maximum performance. QUALIFICATIONS
Education & Licensing
Medical Doctor degree from an accredited college or university required! . Active MD license required. Valid driver's license required. Strong p! harmaceutical expertise preferred. Chronic Pain Management certification preferred.
Experience
Ten (10) years of related experience required to include one (1) to three (3) years physician advisor experience, three (3) years clinical quality control, and three (3) years supervisor experience. Chronic pain management experience preferred.
Skills & Knowledge
Thorough knowledge of pharmacy with specific management expertise in opioid pain management
Knowledge of utilization review procedures
Knowledge of clinical quality systems and measurements
Solid knowledge of clinical quality systems and measurements
Knowledge of resources available regarding regulations and parameters of third party reimbursement, benefit determinations and payments
Knowledge of statutory requirements of state's jurisdiction/ERISA regulations
Excellent oral and written communication, including presentation skills
PC liter! ate, including Microsoft Office products
Leadership/management/motivational skills
Analytical and interpretive skills
Strong organizational skills
Excellent negotiation skills
Excellent interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit Security Clearance, confirmed via a background credit check, is required for this position.
The statement! s contained in this document are intended to describe the general natur! e and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer
and a
Drug-Free Workplace
MD required
- .
If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Sedgwick CMS.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Thu, 01 Aug 2013 06:16:10 GMT
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