Supports the efforts of the clinical team through collaboration with prescribers and targeted beneficiaries in order to ensure appropriate, evidence-based drug selection and resolve medication-related problems.
Engages in drug utilization review (DUR) by supporting the execution of DUR initiatives via meeting preparation, letter campaigns, and telephonic outreach to members/providers. Supports basic data analytic activities and tracking of interventions, and assists with preparation and documentation of responses to regulatory audits associated with the over utilization program.
Provides medication therapy management (MTM) services via triage of inbound calls to the MTM hotline, monitors fax line for prescriber responses and completion of failed faxes, supports the pharmacist for completion of Comprehensive Medication Reviews (CMRs) through pre-work up and case preparation, communicates with network pharmacies, prescribers, and beneficiaries to provide MTM services.
Engages in quality improvement projects including supporting the execution of prescriber mailings and tracking and maintaining physician and member responses regarding pharmacy quality outreach campaigns.
Documents and records services/activities in appropriate databases/software to ensure compliance with CMS requirements for clinical service offerings assigned in designated area (i.e. MTM services, Quality Improvement Projects, DUR, etc.).
Serve as backup for technicians in the other clinical service departments (Drug Utilization Review, Medication Therapy Management, and Quality Improvement).
Performs other duties as assigned.
Required A High School or GED
Required 1+ year of experience in pharmacy operations managed care, hospitals, and/or retail environments
Intermediate Demonstrated interpersonal/verbal communication skills
Beginner Demonstrated written communication skills
Intermediate Ability to effectively present information and respond to questions from peers and management
Licenses and Certifications: Preferred
Preferred Intermediate Microsoft Excel
Preferred Intermediate Microsoft Outlook
Preferred Intermediate Microsoft Word
Preferred Intermediate Microsoft PowerPoint