Develops software at all layers by programming, designing and testing code to meet requirements; Works with Business Systems Analysts to understand and clarify software requirements and translate into working software.
Develops client communications as needed to explain MedImpact response and/or changes in client responsibilities (related to drug benefit management).Attends client calls as needed to understand and address questions or issues for assigned programs.
Responsible for providing clinical support services to client plan(s) contracting for clinical services; Support services will include, but not limited to, clinical review, analysis, recommendation, decision and documentation of prior authorization requests, medical exception requests, and appeal requests as required by client contracts and Utilization Management delegation agreements.
Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review; Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process.
Responsible for learning the interfaces and systems setup between the applications and external entities and ensure their working. On issues, should be able to reach out to the external contacts for further diagnosis and resolutions.
Develop and manage client specific, strategic, financial and business relationship plans that encompass client's goals, performance expectations and growth in membership and profitability in pursuit of meeting department and organizational business metrics.
Understands and promptly responds to a crisis and provide quick remedies for the continuation of the operations. Diagnose, identifies, isolates, and resolves issues in the production environment utilizing various maintenance tools, process and technical experience
Analyzes, defines, and documents requirements for data, workflow, logical processes, hardware and operating system environment, interfaces with other systems, internal and external checks and controls, and outputs