Duties

Primary responsibility is to perform comprehensive medication reviews telephonically with members to identify medication related problems.
Target Members for interactive consultations based on a variety of risk stratification scenarios.
Perform interactive consultations and makes recommendations/interventions for Members and Providers, appropriately documents all pharmacotherapy interventions, responds to questions and provides clarification for requests generated in regard to MTM/DTM programs.
Present all relevant DTM/MTM program materials to P&T Committees as well as any other internal or external review required by assigned plan.
Handle calls and correspondence from Providers; responds to inquiries and complaints. Document calls in inquiry tracking system. Using established protocols ensures resolutions provided are presented in a clear and accurate manner. Receive escalated calls that cannot be clinically resolved by 1st level intervention. Research, resolve and respond to Provider clinical inquiries regarding DTM.
Support Fraud and Abuse program system oversight. Communicate to Compliance any suspected fraud discovered. Recommend course of action for Providers where patterns appear outside of guidelines and generally accepted pharmacy standards.
Analyze reports for Members identified as opioid over utilizers. Conduct consultations with prescribers and submit point-of-sale edits to claims processor for members over utilizing opioids.
Serve as second line contact for all ACFC pharmacy related issues. Ensures internal changes that may affect network services are reflected in the claims processing system.
Represent PerformRx in contacts with Providers, Members, hospital personnel, etc. Demonstrate an understanding of PerformRx's protocols for dealing with external organizations, groups, vendors, and individuals.
Keep abreast of industry trends and regulatory changes in the pharmacy industry and evaluates their effect on pharmacy contracts and services. Make recommendations on program improvements, based on findings and utilization.
Assist in implementation of new DTM programs.
Coordinate with internal departments and external clients on DTM projects.
Serve as a resource to resolve issues identified by DTM Technicians and DTM Analyst.
Serve as central point of information distribution to members of Pharmacy staff.
Review appropriate clinical material (primary literature, clinical guidelines, etc.) and monitor new drugs released to market to update clinical recommendations for gaps in care algorithms for internal and external clients.
Assist in coordinating department staff projects including coordinating patient care with internal and external practitioners, pharmacist disease specialties, pharmacy journal club, and new drug information.
Maintain a balance of productivity, quality, and timeliness of job accountabilities. Participate in department self-audit procedures for on-going evaluation of services.
Assist in coordination of pharmacy student and pharmacy intern projects.


Skills

Minimum two (2) years' current/recent direct patient contact and clinical pharmacy experience preferred
Minimum three (3) years' current/recent professional pharmacy experience preferred
MTM/DTM certificate training preferred

Eduaction

Bachelor's Degree is required
Current pharmacy license, Commonwealth of Pennsylvania preferred
R.Ph; Pharm. D. preferred