Pharmacy Completion Analysis (Fully Remote)

Description

Who We Are

Founded in 1983, the Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement.

At MRIoA, we believe our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of our team.

What We Offer

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

Position Summary:

A Pharmacy Completion Analyst is responsible for carrying out day-to-day departmental tasks and completing all processes for receiving and reviewing Reviewer decisions, issuing appropriate, timely, and accurate review outcome notifications, and maintaining online case summary/tracking information.

Roles

• To finalize the pharmacy case review process and issue review outcome notifications to the appropriate parties of the case.
• To serve as a company liaison with clients, Reviewers, and practitioners/providers/ facilities whose services are subject to review.

Major Responsibilities or Assigned Duties:

• Evaluate opinions submitted by Reviewers upon conclusion of their reviews for compliance with company standards for completeness.
• Follow-up with Reviewers whose submitted opinions do not meet all compliance standards.
• Issue oral and written review outcome notifications that comply with standards and requirements for timeliness, content, recipients, and accuracy, including written notification grammar and spelling.
• Upload completed decisions into client portals in a timely and appropriate manner.
• Research clients’ questions about review processes and/or Reviewer decisions
• Determine the need for additional information or additional review and notify the client and internal departments of these needs.
• Provide backup support to staff in other areas as applicable.
• Support all Quality Management initiatives.
• Actively participate in the Complaint Process and Provider Relations Assessment process.
• Support all Compliance Program activities.
• Participate in all company meetings and committees as requested.
• Maintain a flexible schedule to meet client needs.
• Adapt to differences of clients.
• Adhere to all policies and procedures.
• Take feedback and responsibility for performance.
• Complete other duties and responsibilities as directed.
• Monitor and track out-of-production tasks and hours.
• Adapts to the differences between clients.

Requirements

Skills and Experience

• Minimum of 1 year of Pharmacy experience
• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high-priorities
• Ability to work independently with minimal supervision
• Personal computer literacy and high competency in the use of Microsoft Office
• Strong organizational skills with strong attention to detail
• Excellent critical thinking capabilities
• Strong oral and written communication skills
• Outstanding customer service skills

Education

• High school diploma or equivalent

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.