Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Clinical Pharmacy Program Specialist - Remote
Job Description Summary
This position is responsible for the management of Medication Therapy Management (MTM) and quality programs. It requires extensive knowledge of medications, disease states, pharmacy sig codes, Centers for Medicare and Medicaid technical specifications and regulations, and extensive knowledge of MTM, quality, pharmacy, and medical services. Additional responsibilities include communications with patients, pharmacists, interns, clients, and vendors. Responsible for ensuring all client, CMS requirements, and quality targets are being met.
Job Description
- Maintain required documentation for all activities and medication recommendations.
- Through collaboration with IT and analytics departments, develop and track the appropriate metrics to monitor the quality, and effectiveness of MTM and quality programs.
- Develop and enhance current reporting metrics to provide continuous quality improvement efforts.
- Generate outcomes reporting using outreach activity reports and pharmacy/medical data for direct client deliverables.
- Collaboratively work with clients, providers, and pharmacists to ensure optimal pharmaceutical care.
- Maintains HIPAA standards and confidentiality of protected health information.
- Evaluate and incorporate clinical technical specifications from CMS, National Committee for Quality Assurance (NCQA), and Pharmacy Quality Alliance (PQA) on a recurring basis to ensure MTM and quality programs are being executed to the highest standard and in full compliance.
- Generate and enhance clinical outreach materials to maximize program results.
- Assist and participate in meeting company and department goals such as quality improvement activities.
- Ensure outbound calls are made and provide support to the pharmacists, pharmacy interns, and technicians performing MTM, clinical, and quality program outreach.
- Ensure the team is compliant with CMS requirements, HIPAA, and Fraud Waste and Abuse.
- Audit the MTM and quality program processes to ensure all documentation is appropriate and CMS compliant.
- Communicate effectively with the Clinical Pharmacy Team to address any ongoing issues or problems.
- Coordinate with multiple vendors to drive results in a timely manner.
- Utilize medical claims expertise to identify new areas of opportunity for MTM and quality programs.
- Generate detailed MTM and quality program outcomes data by analyzing pharmacy and medical data.
- Assist leadership with CMS auditing and HPMS contract submissions.
- Other duties as assigned.
Responsibilities
- Bachelor's degree required with 3 years' healthcare experience. May consider an additional 4 years of relevant experience (for a total of 7 years of experience minimum) in lieu of Bachelor's degree.
- Ability to develop and operationalize policies and procedures.
Must be extremely detail oriented and very organized.
Ability to work in a high stress environment and manage multiple complex responsibilities.
Exceptional written and verbal communication skills.
Superior analytical, organizational and problem solving skills.
Consensus builder who strives to develop partnerships, teamwork and good working relationships.
Proven experience working with Microsoft Office Product Suite and databases.
Comfortable with and ability to thrive in an ever-changing environment.
Ability to think through issues and recommend effective solutions.
Excellent time-management and multi-tasking skills.
Analytical proficiency in evaluation of pharmacy and medical data.
Work Experience
Work Experience - Required:
Healthcare
Work Experience - Preferred:
Education
Education - Required:
A Combination of Education and Work Experience May Be Considered., Bachelors
Education - Preferred:
Certifications
Certifications - Required:
Certifications - Preferred:
CPT - Certified Pharmacy Technician - Pharmacy - Pharmacy
Potential pay for this position ranges from $47,500.00 - $71,240.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
