Administrator/Executive occupation at Placements USA LLC in Memphis

Placements USA LLC is currently seeking to employ Administrator/Executive on Mon, 07 Oct 2013 13:26:43 GMT. Administrator/Executive - Physician Pharmacy & Utilization Advisor 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...

Administrator/Executive

Location: Memphis Tennessee

Description: Placements USA LLC is currently seeking to employ Administrator/Executive right now, this occupation will be placed in Tennessee. For detail informations about this occupation opportunity kindly see the descriptions.

• Physician Pharmacy & Utilization Advisor

To conduct physician advisor reviews on clinically complex pharmacy claims and other non-approved utilization review (U! R) 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 satisfaction, and renewal of managed care products.

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 suppli! er 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 procedures 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.

Performs other duties as required.
Supports the organization's quality program(s).
Travels as required.

QUALIFICATIONS

Medical degree from an accredited college or university required. Active MD license required. Valid driver's license required. Strong pharmaceutical expertise preferred. Chronic Pain Management certification preferred.

Experience
Ten (10) years of related experience r! equired 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 literate, including Microsoft Office products
Leadership/management/motivational skills
Analytical and interpretive skills
Strong organizational skills
Excellen! t negotiation skills
Excellent interpersonal skills

Must h! ave the ability to think on your feet and meet deadlines.

Full background check along with security clearance is required for this position.

Please call Cyn Doyle 800-407-3530 or email: cyn@placementsusa.com
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Placements USA LLC.

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: Mon, 07 Oct 2013 13:26:43 GMT

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