Job Description
Type of Requisition:
Regular
Clearance Level Must Currently Possess: None
Clearance Level Must Be Able to Obtain: None
Public Trust/Other Required: None
Job Family: Healthcare Services
Job Qualifications: Skills: Call Center, Clinical Pharmacy, Medicaid, Pharmacy, Pharmacy Services
Certifications: None
Experience: 1 + years of related experience
US Citizenship Required: Yes
: HEALTHCARE CLINICAL EVALUATOR PRINCIPAL
Responsible for reviewing prior approval requests by reviewing patient-specific clinical documentation, treatment history, and preferred drug list.
- You will work as a individual contributor to ensure that prior approval requests are adjudicated in a timely manner assisting with meeting SLA requirements.
- You will be working with a team of Pharmacists and pharmacy technicians to ensure that we are properly adjudicating prior approval requests in accordance with North Carolina's approved criteria. Answer incoming calls related to PA requirements, status updates,
- Or general inquiries, providing world class customer service.
- Recognizes, evaluates, interprets, recommends and implements policies and procedures for specific components of pharmacy services.
- Provide Pharmacy expertise in prior approval of pharmacy services.
WHAT YOU'LL NEED TO SUCCEED
Bring your health discipline expertise and drive for innovation to GDIT. The Healthcare Clinical Evaluator Principal must have:
• Education: PharmD or undergraduate in Pharmacy with residency or advanced clinical experience. Unrestricted State Licensure Required (NC).
• Experience: 4+ years of related experience
• Working knowledge of how to navigate computer system, emails, Microsoft suite (Word, Excel, and PowerPoint etc.), and telephone software.
• Security clearance level: None
• US citizenship required
• Required Skills and Abilities: Ability to work independently, strong work ethic, critical thinking, ability to problem solve and facilitate agreement, ability to work a weekly rotating schedule to include weekends and holidays.
Preferred skills:
• Familiarity with Medicaid, Medicare Part D, or PBM operations. Prior experience with call center operations or customer service roles a plus.
• Location: Hybrid
Our hours of operation are 7:00 am to 11:00 pm Monday thru Friday. 7:00 am to 6:00 pm Saturday, Sunday and holidays.
Rotation 1: Scheduled to work the weekend. Saturday and Sunday 6:45 am-6:00pm will have another day during the week between 9:00 to 3:00.
Rotation 2: Scheduled to work 7:00-3:30
Rotation 3: Scheduled to work closing 2:30-11:00
Holidays scheduled to work 6:45-6:00
GDIT IS YOUR PLACE
At GDIT, the mission is our purpose, and our people are at the center of everything we do.
• Growth: AI-powered career tool that identifies career steps and learning opportunities
• Support: An internal mobility team focused on helping you achieve your career goals
• Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off
• Flexibility: Full-flex work week to own your priorities at work and at home
• Community: Award-winning culture of innovation and a military-friendly workplace
OWN YOUR OPPORTUNITY
Explore a career in health at GDIT and you'll find endless opportunities to grow alongside colleagues who share your sense of purpose for making a difference.
The likely salary range for this position is $64,899 - $87,805. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
Scheduled Weekly Hours: 24
Travel Required: None
Telecommuting Options: Hybrid
Work Location: USA NC Raleigh
Additional Work Locations: Total Rewards at GDIT: Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.
We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.
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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans
Job Tags
Temporary work, Full time, Immediate start, Remote work, Worldwide, Flexible hours, Saturday, Sunday, Monday to Friday,