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, Health Plans, Medicaid, Pharmacy

Certifications:

None

Experience:

7 + years of related experience

US Citizenship Required:

No

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.

The likely salary range for this position is $29,665 - $40,135. 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:

8

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.

Join our Talent Community to stay up to date on our career opportunities and events at

gdit.com/tc.

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans