Apply critical thinking to achieve proper clinical decisions when performing clinical reviews
Utilize multiple systems and other clinical resources to achieve proper decisions in utilization management reviews
Work and maneuver within queue systems that prioritize clinical reviews
Be able to make a clinical decision quickly and decide and act with or without all information
Evaluate opportunities for cross-benefit drug management in an integrated model
Provide support to the condition-based program managers to enhance clinical affordability and total health outcome
Evaluate the success of current utilization management program to determine areas of enhancement
Review current utilization management strategies to ensure strategies promote affordability and customer experience
Provide education and training for clinical team to communicate clinical strategy and actions and assure consistent execution of class strategy
Examine egregious medications/products and coordinate with clinical program directors to provide appropriate clinical recommendations to minimize client and customer cost
Work and collaborate with a multi-disciplinary clinical team to provide a customer centric experience
Serves as a resource to facilitate understanding of medication related products
Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally
