The #1 Site for Finance Jobs - search all Finance jobs.

Sr. Clinical Pharmacist

Description

The Rawlings group, founded in 1977, is the premier leader in payment integrity services to the health insurance industry.  Located in La Grange, KY, The Rawlings Group employs over 1,400 people and is growing.  If you are looking for a great opportunity to make positive impact on the future of healthcare, The Rawlings Group needs to be your career choice.

Rawlings Pharmacy Division has created a new position due to business growth and is seeking a professional pharmacist to assist with the development of new payment integrity initiatives supporting the growth of programs providing prescription drug cost-containment and Medicare compliance services to health plan clients.

The Senior Clinical Pharmacist is a new role and will be a member of the Pharmacy Division leadership team reporting to the Division President.  In this position you would have a primary focus of expanding existing audit, recovery and compliance products, and developing new initiatives to achieve divisional growth objectives.  The Senior Clinical Pharmacist will apply clinical and claim processing concepts to analyze large data sets across both medical and pharmacy claim data and create expanded cost containment opportunities for our clients. They will also provide support and consultation with implementing client and internal program initiatives across multiple teams specialized in drug claim payment integrity and compliance services. 



ESSENTIAL DUTIES & RESPONSIBILITIES
 
 

 

  • Lead the development of business requirements to implement new initiatives, requiring complex data analysis applied to pharmacy and medical data, to achieve program objectives and create value for health insurance and pharmacy benefit manager clients.

  • Transform data analysis of health insurance and pharmacy benefit claims data into new ideas to generate cost containment and financial recoveries for clients.

  • Demonstrate initiative in identifying process improvements and procedures to increase the expertise and success of the division’s audit, recovery and compliance teams.

  • Provide clinical support and direction to Team Managers, including identifying training and developmental opportunities to improve team skills and performance.

  • Provide timely and accurate reporting and analysis of key performance metrics and trends to management.

  • Assist with management analysis of divisional performance results and client-specific metrics to identify opportunities for improvement and develop correction action plans.

  • Actively participate in the strategic planning for the division, contributing meaningful ideas and concepts to achieve growth objectives.

Requirements

SKILLS & ABILITIES
 

 

  • Demonstrated leadership abilities, including achieving team goals, objectives and priorities.

  • Proven experience applying health insurance and clinical data to accomplishing business objectives and outcomes.

  • Strong analytics skills collecting and organizing health insurance and clinical data, developing reporting and preparing detailed analysis.

  • Ability to apply critical thinking to develop recommendations for product enhancements or new initiatives to assist health plan and pharmacy benefit manager clients with cost containment or compliance objectives.

  • Strong verbal and written communication skills, with experience to persuade, motivate and inspire.

  • High level of commitment to outstanding internal and external client service



 

 
EDUCATION REQUIREMENTS
 

 

  • Bachelor’s Degree in related field required, Advanced Degree preferred

  • Licensed Pharmacist (RPh)

Job Snapshot

Location US-KY-La Grange
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Pharmaceutical, Insurance, Health Care
Apply

Company Overview

Rawlings Group

The Rawlings Group was formed in 1977 to offer legal services to insurance providers. Recognizing the need for specialized recovery services, Rawlings launched what would ultimately become the first subrogation outsourcing program for the healthcare industry. We subsequently launched other outsourcing programs specifically dedicated to medical claims recovery, mass tort litigation, and pharmaceutical claims recovery. Learn More

Contact Information

US-KY-La Grange
Snapshot
Rawlings Group
Company:
US-KY-La Grange
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Pharmaceutical, Insurance, Health Care
Store Type:

Description

The Rawlings group, founded in 1977, is the premier leader in payment integrity services to the health insurance industry.  Located in La Grange, KY, The Rawlings Group employs over 1,400 people and is growing.  If you are looking for a great opportunity to make positive impact on the future of healthcare, The Rawlings Group needs to be your career choice.

Rawlings Pharmacy Division has created a new position due to business growth and is seeking a professional pharmacist to assist with the development of new payment integrity initiatives supporting the growth of programs providing prescription drug cost-containment and Medicare compliance services to health plan clients.

The Senior Clinical Pharmacist is a new role and will be a member of the Pharmacy Division leadership team reporting to the Division President.  In this position you would have a primary focus of expanding existing audit, recovery and compliance products, and developing new initiatives to achieve divisional growth objectives.  The Senior Clinical Pharmacist will apply clinical and claim processing concepts to analyze large data sets across both medical and pharmacy claim data and create expanded cost containment opportunities for our clients. They will also provide support and consultation with implementing client and internal program initiatives across multiple teams specialized in drug claim payment integrity and compliance services. 



ESSENTIAL DUTIES & RESPONSIBILITIES
 
 

 

  • Lead the development of business requirements to implement new initiatives, requiring complex data analysis applied to pharmacy and medical data, to achieve program objectives and create value for health insurance and pharmacy benefit manager clients.

  • Transform data analysis of health insurance and pharmacy benefit claims data into new ideas to generate cost containment and financial recoveries for clients.

  • Demonstrate initiative in identifying process improvements and procedures to increase the expertise and success of the division’s audit, recovery and compliance teams.

  • Provide clinical support and direction to Team Managers, including identifying training and developmental opportunities to improve team skills and performance.

  • Provide timely and accurate reporting and analysis of key performance metrics and trends to management.

  • Assist with management analysis of divisional performance results and client-specific metrics to identify opportunities for improvement and develop correction action plans.

  • Actively participate in the strategic planning for the division, contributing meaningful ideas and concepts to achieve growth objectives.

Requirements

SKILLS & ABILITIES
 

 

  • Demonstrated leadership abilities, including achieving team goals, objectives and priorities.

  • Proven experience applying health insurance and clinical data to accomplishing business objectives and outcomes.

  • Strong analytics skills collecting and organizing health insurance and clinical data, developing reporting and preparing detailed analysis.

  • Ability to apply critical thinking to develop recommendations for product enhancements or new initiatives to assist health plan and pharmacy benefit manager clients with cost containment or compliance objectives.

  • Strong verbal and written communication skills, with experience to persuade, motivate and inspire.

  • High level of commitment to outstanding internal and external client service



 

 
EDUCATION REQUIREMENTS
 

 

  • Bachelor’s Degree in related field required, Advanced Degree preferred

  • Licensed Pharmacist (RPh)

Mxb3jc5ycvdlv4jbnrb
MoneyJobs Advice

For your privacy and protection, when applying to a job online: Never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction.Learn More

By applying to a job using moneyjobs.com you are agreeing to comply with and be subject to the workinretail.com Terms and Conditions for use of our website. To use our website, you must agree with theTerms & Conditionsand both meet and comply with their provisions.
Sr. Clinical Pharmacist Apply now