Medical Claims Review Manager jobs in Oceanside, CA

This position will serve as an integral member of Medical information (MI) and Medical Review (MLR/MRC) teams responsible for medical accuracy review as part of the Promotional Review Committee and Medical Review Committee, the support of the Medical Information Call Center (MICC), including the development and maintenance of MI content, as well as operational and scientific support for key strategic Medical Affairs initiatives.

• Participates in the review of promotional and medical materials to ensure medical accuracy.
• Maintains an understanding of product knowledge and labeling, associated disease states, relevant literature, treatment guidelines, competitor information, and marketing strategies and tactics for assigned therapeutic area(s).
• Critically evaluates literature, interprets complex data, writes efficiently, and communicates recommendations to counterparts from cross-divisional functional areas.
• Collaborate cross-functionally with internal collaborators, including MSL field directors, training, medical information, publications, HEOR, clinical development, and pharmacovigilance to identify, develop, and review scientific content for external use by Medical Affairs.
• Develops and manages a Medical Reference Library as well as a Medical digital asset management system to ensure references are up-to-date and linked to materials as appropriate.
• Develops MI content, including verbal responses (FAQs) and standard response letters (SRLs) to be used by the MICC and Medical Information team.
• Leads the development of custom responses for specific requests that require escalated attention.
• Ensure the responses to inquiries are provided in an accurate and timely manner.
• Develops Medical Information reports to assist with identifying data gaps and communicating key performance indicators.
• Monitors the Medical Information and Medical Affairs inbox for inquiries.
• Provides support for compendia updates.
• Other duties as assigned

• Requires a PharmD or advanced degree in a scientific subject area.
• Targeting 3 years' progressively responsible experience in the pharmaceutical industry in medical affairs, medical communications, medical information, scientific affairs, or similar area, or completion of a pharmaceutical industry fellowship. Previous experience in neurology, psychiatry and/or rare disease preferred.
• An equivalent combination of relevant education and experience may be considered.
• Understanding of the US healthcare environment, FDA and other federal regulations, and ethical guidelines.
• Strong written and verbal communication skills with the ability to handle information flow among a variety of partners.
• Ability to run multiple projects simultaneously.
• Excellent organizational and multi-tasking skills.
• Ability to promote team cooperation and a dedication to team success.
• Self-directed with sense of urgency with commitment to tasks at hand.
• Ability to build and sustain trusted relationships both internally and externally.

While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, see, talk or hear in a standard office environment and independently from remote locations. Employee must occasionally lift and/or move up to 20 pounds. Ability to travel independently overnight and work after hours if required by travel schedule or business issues.

#LI-KA1 #LI-HYBRID