Medication Management Specialist

Capital Health Plan•Tallahassee, FL

3d•Onsite

About The Position

Join Capital Health Plan as a full-time Medication Management Specialist to maintain regulatory compliance and ensure we can continue to serve our patients' healthcare needs. Accuracy and attention to detail are crucial in this role, as you'll be directly overseeing the regulatory and accreditation requirements related to the pharmacy benefit. You'll ensure that all activities comply with regulations, maintain departmental files, and participate in timely data validation for internal and external audits. In coordination with the pharmacy benefit manager, you'll manage formulary oversight and assist with medication coverage determinations. Diligently, you'll review pharmacy utilization reports, identify any discrepancies, and follow the proper reporting procedures as needed. You'll also maintain and update vital documents/content, including departmental policies listed on our website and a list of medications for review under the medical benefit. The medication management committee holds quarterly meetings, and you'll prepare the materials and handle communications for them. You'll collaborate cross-departmentally and assist with other responsibilities as needed to maintain fully compliant operations.

Requirements

At least 4 years of related experience in a Medicare Advantage or commercially managed care environment.
Valid Florida RN, LPN, or pharmacy technician (CPhT/RPhT) certification.
2-year college/technical school degree OR 1+ years of related experience/training OR an equivalent combination of education and experience.
Knowledge and understanding of HIPAA regulations, clinical patient care, various diseases and medications, regulatory/accreditation requirements, and pharmacy benefit management.
Strong language skills for effectively reading, analyzing, interpreting, and writing professional journals, technical documents, business reports, and procedure manuals.
Effective verbal/written communication and presentation skills for engaging with managers, clients, and the public.
General math skills (addition, subtraction, multiplication, division, fractions, decimals, ratios, bar graphs, etc.).
High-level reasoning, problem-solving, and clinical research skills.
Proficiency in Microsoft Office, internal database software, and document/statistic production.
Ability to perform the physical duties of the role, including frequently reaching, using hands/fingers/arms, bending, climbing stairs, and crouching.
Ability to pass a background check and drug screening test.

Responsibilities

Oversee regulatory and accreditation requirements related to the pharmacy benefit.
Ensure all activities comply with regulations.
Maintain departmental files.
Participate in timely data validation for internal and external audits.
Manage formulary oversight in coordination with the pharmacy benefit manager.
Assist with medication coverage determinations.
Review pharmacy utilization reports and identify discrepancies.
Follow proper reporting procedures for discrepancies.
Maintain and update departmental policies listed on the website.
Maintain a list of medications for review under the medical benefit.
Prepare materials and handle communications for quarterly medication management committee meetings.
Collaborate cross-departmentally to maintain compliant operations.
Assist with other responsibilities as needed.