Pharmacy Medication Management Specialist (Short-Term Assignment)

Inland Empire Health Plan•Rancho Cucamonga, CA

3d•Remote

About The Position

This is a short-term assignment where you will find joy in serving others with IEHP by "healing and inspiring the human spirit." Under the direction of the Medication Management Pharmacy Operations Supervisor, the Pharmacy Medication Management Specialist is responsible for preparing member medication reconciliations, comprehensive medication reviews (CMRs), and targeted medication reviews (TMRs), including their respective written notifications to providers/members for clinical review. The specialist must utilize all policies and resources to answer questions and direct Providers/Members appropriately to resolve concerns, accept and make phone calls concerning all facets of medication management, and schedule appointments. The role requires the ability to listen to Provider/Member concerns and questions, accurately document medication/allergy history, and communicate health plan processes clearly and knowledgeably. Additionally, the specialist will be responsible for the technical review of prescription drug prior authorizations and notifying the provider of the clinical decision.

Requirements

One (1) or more years of experience as a pharmacy technician in a pharmacy required
High School Diploma or GED required
Possession of an active, unrestricted, and unencumbered Pharmacy Technician license issued by the California State Board of Pharmacy required
Knowledge in pharmaceutical terminology is required
Microsoft Office (Microsoft Excel skills preferred)
Excellent organizational, written, and verbal communication required
Good interpersonal skills.
Excellent critical thinking skills
Typing speed of 40 corrected words per minute (CWPM) required
Highly motivated and self-starter.
Detail-oriented
Display the ability to adapt and perform duties efficiently whenever unexpected changes arise
Works well in a fast-paced environment

Nice To Haves

Experience in a pharmacy benefit management setting preferred
Associate’s degree or Bachelor’s degree from an accredited institution preferred
Project management skills preferred

Responsibilities

Technical review of authorizations (drug) that includes reviewing authorization, chart notes, and/or relevant clinical information to render a clinical recommendation.
Decision prior authorizations within compliance turnaround times and quality standards meeting regulatory requirements as defined by Department of Health Care Services, Center for Medicare & Medicaid Services, California Department of Managed Health Care, and National Committee for Quality Assurance.
Preparation of medication reconciliation reviews, CMRs and TMRs that includes reviewing chart notes, electronic medical records, and/or relevant clinical information to submit for pharmacist clinical review/recommendation.
Provide excellent customer service on all inbound and outbound calls, demonstrating a high level of patience and respect, avoiding distractions, and ensuring prompt and appropriate assistance for a positive provider/member experience.
Communicate with providers (doctor and pharmacy) and members on issues related to medication reconciliation, or respective policies and procedures.
Access electronic medical records (EMRs), claims systems (PBM and medical claims), and other information systems to thoroughly document medication reconciliation reviews, CMRs, TMRs, and prior authorizations in relevant program systems.
Ensure all departmental goals (including, but not limited to turnaround, production expectations, and quality metrics) are met.
Ensure all company’s goals (including, but not limited to the 5 Strategic Priorities: Quality of Care and Service, Access to Care, Practice Transformation, Human Development and Technology and Data Analytics) are met.
Communicate with providers (doctor and pharmacy) on issues related to the IEHP formulary, non-formulary criteria, or respective policies and procedures.
Interface with IEHP’s pharmacy benefit management (PBM) company, when necessary, in regard to adjudication and medication processing issues.
Assist in expedited review of discharge related orders or requests and coordination with specialty pharmacy providers (disease therapy management program), and internally with Utilization Management, Behavioral Health, or Care Management departments.
Assist Clinical Pharmacist in review of Member’s medication regimen and assist in care coordination internally with Utilization Management, Behavioral Health, or Care Management departments.
Actively participate in internal quality improvement process enhancements, LEAN projects, and managing for daily improvement (MDI).
Participate in various pharmacy projects to meet the standards of Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS).
Participate in team training and professional development of prior authorization processing, pharmacy claims, grievances, discharges, and any related pharmacy issues.
Assist with direction on the IEHP Provider webpage as needed.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.