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.