Location: Remote. Candidates must reside in Southern California near Rancho Cucamonga, CA.
Description:
Impresiv Health is seeking a Pharmacy Medication Management Specialist for a short-term assignment supporting medication management and pharmacy operations for a healthcare organization.
Under the direction of the Medication Management Pharmacy Operations Supervisor, this role is responsible for preparing medication reconciliations, Comprehensive Medication Reviews (CMRs), Targeted Medication Reviews (TMRs), and associated written notifications for pharmacist clinical review.
The Pharmacy Medication Management Specialist will also support prescription drug prior authorization reviews, communicate with providers, pharmacies, and members, document medication and allergy histories, and assist with medication management processes while meeting established quality, productivity, and regulatory requirements.
What You Will Do:
- Perform technical reviews of prescription drug prior authorizations, including review of authorization requests, chart notes, and relevant clinical information to develop clinical recommendations.
- Process prior authorizations within required compliance turnaround times and quality standards established by applicable regulatory and accreditation requirements.
- Prepare medication reconciliation reviews, Comprehensive Medication Reviews (CMRs), and Targeted Medication Reviews (TMRs) by reviewing chart notes, electronic medical records, and other relevant clinical information for pharmacist review.
- Provide excellent customer service on inbound and outbound calls while communicating professionally and respectfully with providers, pharmacies, and members.
- Communicate with providers, pharmacies, and members regarding medication reconciliation, medication management processes, and applicable policies and procedures.
- Access electronic medical records, pharmacy benefit management systems, medical claims systems, and other information systems to document medication reconciliation reviews, CMRs, TMRs, and prior authorizations.
- Meet established departmental turnaround times, productivity expectations, and quality metrics.
- Support organizational goals related to quality of care and service, access to care, practice transformation, human development, technology, and data analytics.
- Communicate with providers and pharmacies regarding formulary requirements, non-formulary criteria, policies, and procedures.
- Interface with the pharmacy benefit management organization as needed regarding medication adjudication and processing issues.
- Assist with expedited review of discharge-related medication orders or requests and coordinate with specialty pharmacy providers and internal departments, including Utilization Management, Behavioral Health, and Care Management.
- Assist Clinical Pharmacists with review of member medication regimens and care coordination.
- Participate in internal quality improvement initiatives, LEAN projects, and Managing for Daily Improvement activities.
- Participate in pharmacy projects supporting Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) standards.
- Support pharmacy utilization management reviews, provider and pharmacy outreach, formulary alternative conversion, and discharge medication transition activities.
- Participate in team training and professional development related to prior authorization processing, pharmacy claims, grievances, discharges, and other pharmacy-related matters.
- Assist with provider webpage navigation and direction as needed.
- Perform other duties as required to support health plan operations and departmental business needs.
You Will Be Successful If:
- You have strong knowledge of pharmaceutical terminology.
- You have excellent organizational, written, and verbal communication skills.
- You demonstrate strong interpersonal and critical-thinking skills.
- You can type at least 40 corrected words per minute (CWPM).
- You are highly motivated, self-directed, and detail-oriented.
- You can adapt and perform duties efficiently when unexpected changes arise.
- You work effectively in a fast-paced environment.
- You can provide professional and respectful service when communicating with providers, pharmacies, and members.
- You can accurately document medication information and navigate multiple healthcare information systems.
What You Will Bring:
- High School Diploma or GED.
- One (1) or more years of experience as a pharmacy technician in a pharmacy.
- Active, unrestricted, and unencumbered Pharmacy Technician license issued by the California State Board of Pharmacy.
- Knowledge of pharmaceutical terminology.
- Microsoft Office skills.
- Excellent organizational, written, and verbal communication skills.
- Good interpersonal skills and excellent critical-thinking skills.
- Typing speed of at least 40 corrected words per minute (CWPM).
- Ability to work effectively in a fast-paced environment.
- Highly motivated, self-directed, and detail-oriented.
- Ability to adapt and perform duties efficiently when unexpected changes arise.
Preferred Qualifications
- Experience in a pharmacy benefit management setting.
- Associate’s degree or Bachelor’s degree from an accredited institution.
- Microsoft Excel skills.
- Project management skills.
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That’s Impresiv!
