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.