Job Description

Public Trust: None

Requisition Type: Regular

Your Impact

Own your opportunity to work alongside federal civilian agencies. Make an impact by providing services that help the government ensure the well being of U.S. citizens.

Job Description

HEALTHCARE CLINICAL EVALUATOR PRINCIPAL

Solve real-world challenges that impact the frontlines of public health, life science, and clinical research initiatives as a Healthcare Clinical Evaluator Principal at GDIT. You’ll support the mission and grow with it, building a meaningful career in health.

MEANINGFUL WORK AND PERSONAL IMPACT
As a Healthcare Clinical Evaluator Principal, the work you’ll do at GDIT will be impactful to the mission of North Carolina MMIS. You will play a crucial role in

• 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 medical expertise in prior approval pharmacy services.

WHAT YOU’LL NEED TO SUCCEED

• Bring your Pharmacy expertise and drive for innovation to GDIT. The Healthcare Clinical Evaluator Principal must have:
• Education: DDS/MD/PharmD
• Experience: 8+ years of related experience
• Technical skills: Ability to work independently, strong work ethic, critical thinking skills
• Working knowledge of how to navigate computer systems, email, Microsoft suite (Word, Excel, and PowerPoint etc.), and telephone software.

Role requirements:

• Familiarity with Medicaid, Medicare Part D, or PBM operations. Prior experience with call center operations or customer service roles a plus
• Location: Hybrid
• US Citizenship Required

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.

Work Requirements

Years of Experience

7 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

None

Job Tags

Part time, Flexible hours,

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