Job Description

THIS ROLE IS FULLY REMOTE

Summary/Position Objectives:

The MTM pharmacy benefit coordinator is responsible for supporting clinical outreach services to our members, their pharmacies and their healthcare providers to ensure member safety, minimize gaps in care, identify cost-effective medication strategies and coordinate care to improve healthcare outcomes for our members.  The position will support HEDIS adherence initiatives and work to support longitudinal improvement goals.

In addition, the Pharmacy Benefit Coordinator performs a variety of routine to moderately complex administrative and pharmacy-related tasks that support the Pharmacy Management team within the department.  The Pharmacy Management team is responsible for the management of the pharmacy benefit for Maryland Physicians Care, a Medicaid MCO in collaboration with the pharmacy benefit management (PBM) vendor and other internal departments.  This position will ensure a high level of quality and accuracy in the pharmacy benefits administered while also delivering excellent member services.  This position will also support the organization’s utilization review, quality improvement, provider relations, and population health initiatives.

Responsibilities: 

Essential Functions:

• Provide medication therapy management support to MPC members including but not limited to, comprehensive medication reviews, disease specific medication reviews, assessment of adherence barriers, and optimization of medication management to support HEDIS related adherence measures.
• Communicate professionally to discuss MTM analysis to providers and interdisciplinary care teams.
• Work collaboratively with quality management to support HEDIS adherence projects.
• Supports the accurate implementation and coding of pharmacy benefit, formulary, and program changes, including review of PBM testing scenarios.
• Reviews pharmacy services recommended for denial. Of those recommendations, investigates and reviews data and information retrieved from plan providers.
• Assists in the management of members by collecting pertinent information from plan providers and other pharmacy data systems.
• Assists in various pharmacy, utilization review/management, quality improvement, provider relations, and population health initiatives.
• Serves as a pharmacy liaison and resource person to plan pharmacies and members.
• Assists the Pharmacist with monitoring and evaluation of pharmacy utilization.
• Identifies issues and problem areas and participates in the development of solutions.

Secondary Functions:

• Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
• Must maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
• Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.

Knowledge and Skills:

• Ability to identify, communicate findings, and resolve member, provider, process and/or system issues, communicating recommendations verbally and in writing.
• Business writing and presentation skills, including the ability to write clear, concise reports.
• Meticulous attention to detail, including but not limited to interpreting and understanding benefits/codes.
• Demonstrates skills in problem-solving, decision-making, conflict resolution, and the ability to work independently and in a team environment.
• Familiarity with government relations with the ability to operationalize and understand how various aspect of regulation is interdependent and related.
• Excellent organization, time management, project management skills, multi-taking abilities, diplomacy and professionalism plus a strong sense of urgency leading to the timely completion of all projects and assignments.

Education and Work Experience:

• Current Maryland State Pharmacy Technician licensure, including certification from a nationally recognized Pharmacy Technician Certification Board.

• High School diploma or equivalent.
• Minimum three (3) years of experience as a pharmacy technician working in an MTM call center, outpatient pharmacy, or managed care pharmacy.

How to Apply

Job Categories: Equal Opportunities. Job Types: Full-Time. Salaries: 60,000 - 80,000.

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