Revenue Cycle Clinical Advisor – Remote

Why Mayo Clinic

Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans (https://jobs.mayoclinic.org/benefits/) – to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. You’ll thrive in an environment that supports innovation, is committed to ending racism and supporting diversity, equity and inclusion, and provides the resources you need to succeed.

Responsibilities

The Revenue Cycle Clinical Advisor is a medication prior authorization pharmacist responsible for utilizing pharmacy acumen, medication expertise, healthcare payer knowledge, medication guidelines to support prior authorization operations, prior authorization technology, consultation on evidence-based guidelines, reporting and analytics and quality management. Provides clinical advisory support regarding medication prior authorizations, develops programs to facilitate patient speed to therapy and reviews medication prior authorization submissions for quality. Educates prior authorization representatives, pharmacies, providers, and clinic staff on medication prior authorization approval criteria per plan guidelines including tried and failed, plan exclusions, quantity limits, etc. Serves as a clinical subject matter expert on the outpatient prescription prior authorization team. Under the supervision of the senior manager participates in and lead medication denial governance initiatives aimed to identify trends in prior authorization denial volume and develop action plans accordingly. Develops and leads processes to support Mayo Clinic providers with medication prior authorization appeals. Collaborates with department operation analysts to develop effective reports to identify gaps and opportunities. Leverages presentation skills by delivering monthly and quarterly reporting in partnership with the Revenue Cycle leadership team, providers, clinic staff and pharmacies on the clinical aspects of prior authorizations. Maintains current knowledge of industry trends and technological innovations that can be used to improve, streamline, and integrate outpatient pharmaceutical prior authorizations. Maintains current knowledge of federal, state, and commercial insurance authorization requirements as well as appeal rights and responsibilities. Translates the Mayo Clinic and departmental vision into meaningful and effective responses and results. Must be able to operate scope of responsibility through complexity and ambiguity. Participates in the identification of opportunities to improve processes and to function as a catalyst for realizing these improvements. Brings awareness of current external environment issues. Serves as a liaison between departments and agencies inside and outside Mayo.

Qualifications

Graduate of an accredited College of Pharmacy. Doctor of Pharmacy (Pharm.D.) degree or equivalent experience required. Equivalent experience includes at least five years of relevant pharmacy practice.

Current, unrestricted pharmacist license in state of residence.

Previous outpatient or community pharmacy experience preferred. Experience and proven record of success in prior authorization management. Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired. Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessary. Proficiency in drug literature including proficiency with electronic databases (e.g., Micromedex, Medline, and Internet) preferred. Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences. Proficiency in EPIC , MS Word, Excel, and PowerPoint including tables, charts and figures preferred. Demonstrates leadership abilities along with strong interpersonal skills , teamwork and organizational skills. Emphasis on critical thinking skills, including identifying and accepting a challenging situation and creating and implementing a solution. Must be able to relate to, gain support of, and drive consensus with clinicians and administrators for the purposes of operational efficiency. Excellent communication and customer service skills are essential. Must be capable of independent work, with little to no guidance provided exercising good judgment. Must be an individual of high energy with a positive attitude and history of getting results. Experience with or sensitivity to the uniqueness of the patient care environment is mandatory.

This vacancy is not eligible for sponsorship/ we will not sponsor or transfer visas for this position.

This position will accept applications until October 11,2024. This deadline may be extended if the necessary candidate pool is not met by this date.

Exemption Status

Exempt

Compensation Detail

$122,387 – $177,444 / year

Benefits Eligible

Yes

Schedule

Full Time

Hours/Pay Period

80

Schedule Details

100% Remote, can be seated at any site
Standard Days M-F 8 am – 5 pm CST

International Assignment

No

Site Description

Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is. (https://jobs.mayoclinic.org/alllocations)

Affirmative Action and Equal Opportunity Employer

As an Affirmative Action and Equal Opportunity Employer Mayo Clinic is committed to creating an inclusive environment that values the diversity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodations to access job openings or to apply for a job are available.

Recruiter

Ronnie Bartz

Equal opportunity

As an Affirmative Action and Equal Opportunity Employer Mayo Clinic is committed to creating an inclusive environment that values the diversity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodations to access job openings or to apply for a job are available.