MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High School diploma or equivalent
2. National Pharmacy Technician Certification (PTCB or EXCPT)
3. Registered with the WV State Board of Pharmacy as a Pharmacy Technician upon hire.
EXPERIENCE:
1. Two (2) years of experience specific to Medicare Part D
2. Two (2) years of Pharmacy Technician or healthcare related experience
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. Associates degree OR Post high school education in a science field of study OR graduate of a pharmacy technician training program.
2. Experience in Medication Therapy Management, proficiency in utilizing MTM platforms and tools.
3. Experience utilizing Electronic Medical Records, such as EPIC.
4. Experience with Pharmacy Benefit Manager (PBM)
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Evaluate medications for patients as prescribed, ensuring adherence to proper dosage and timing.
2. Makes outbound calls, receives, and responds to calls from both provider/physician’s offices and pharmacies if necessary.
3. Contacts beneficiaries to discuss medication adherence per protocol and escalates to pharmacist as required.
4. Partner with clinical leaders across Peak Advantage to develop, implement, and execute successful medication adherence initiatives.
5. Aligns with the goals, metrics, and ongoing strategy to support a successful initiative to ensure members remain adherent to maintenance medication therapies.
6. Collaborate with healthcare professionals to discuss patient care plans and medication needs.
7. Provide education to patients regarding their medications, including usage, potential side effects, and importance of adherence.
8. Stay updated on medical terminology and best practices related to medication utilization.
9. Adhere to member outreach initiatives to optimize clinical quality and close healthcare gaps.
10. Collaborate with internal departments to educate on quality measures, health plan quality performance, and alignment of clinical and operational departmental goals. Provide regular feedback to ensure compliance with regulatory standards.
11. Collaborate with our internal and external Data Analytics teams to identify opportunities for improvements in patient care.
12. Create engaging member communications and Part D Medication Adherence success.
13. Provides patient-centered care that will improve clinical outcomes and reduce total cost of care.
14. Interact directly with Medicare members and healthcare providers telephonically.
15. Follow up with clinics, providers, pharmacies, and health plan beneficiaries to resolve issues and concerns promptly.
16. Communicates individualized care plans effectively with beneficiaries, healthcare providers, and other members of the care team.
17. Foster ongoing relationships with providers, members, and various internal departments to ensure members are getting appropriate care.
18. Document and record services/activities in appropriate databases/software to ensure compliance with CMS regulations.
19. Supports basic data analytic activities and tracking of interventions and assists with preparation and documentation of responses to regulatory audits.
20. Maintain performance metrics for quality improvement programs related to Medicare Part D.
21. Make and document member/provider outreach interventions to close Part D Star measure open gaps.
22. Refer members as appropriate to Peak Health Plan and/or WVU programs for coordination of care.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to stand and walk short distances for eight or more hours.
2. Frequent bending, stooping, or stretching.
3. Ability to lift 30 pounds and push 50 pounds.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment.
2. Some travel may be required to provider offices and offsite meetings.
SKILLS AND ABILITIES:
1. Ability to work under stressful working conditions.
2. Ability to handle and maintain confidential information.
3. Ability to work cooperatively as a team member with articulate oral and written communication and presentation skills.
4. Ability to work in a fast-paced and rapidly changing environment with attention to detail.
5. Ability to work proactively and independently to research and resolve complex issues.
6. Experience with regulatory and accreditation standards.
7. Ability to apply relevant laws, regulations, requirements, and policy standards.
8. Extensive working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms.
9. Must be able to communicate effectively verbally and in writing and place high emphasis on customer service.
Additional Job Description:
Scheduled Weekly Hours:
40Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)Company:
PHH Peak Health HoldingsCost Center:
2405 PHH Medication Management
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