Revenue Cycle Clinical Advisor - Remote

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.

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.

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 – to take care of you and your family, now and in the future. And with continuing education and advancement oppor