[Hiring] Pharmacy Medication Management Specialist @Impresiv Health

Role 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.
• Supporting prescription drug prior authorization reviews.
• Communicating with providers, pharmacies, and members.
• Documenting medication and allergy histories.
• Assisting with medication management processes while meeting established quality, productivity, and regulatory requirements.

Qualifications

• 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.

Requirements

• 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, CMRs, and 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.

Benefits

• Competitive salary.
• Flexible work environment.
• Opportunities for professional development.