Medication Therapy Adherence Specialist Ii

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Position Title: Medication Therapy Adherence Specialist II

Department: Pharmacy

Title of Manager: Pharmacy Clinical Supervisor

Supervises: Non-supervisory position

Exemption Status: Non-Exempt

Pay and Benefits: Pay and Benefits: Estimated hiring range $51,050 - $61,720 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits.

Posting Notes: Posting Notes: This fully remote role is available to candidates residing in one of the listed 9 states.

Job Summary

The Medication Therapy Adherence Specialist II position is to support member engagement activities which improves the member’s experience of the plan, assist members in adhering to their chronic medications by the identification and removal of medication adherence and coordination barriers. This position also supports member outreach activities based on business needs including activities related to pharmacy benefits administration, such as customer service, PA and appeals support. Additionally, this position provides operational, clerical and project support for pharmacy benefits, Stars and HEDIS initiatives and care coordination support for the pharmacy Regional Care Teams (RCT).

Essential Responsibilities

Member Engagement, CAHPS and Adherence

• Apply motivational interviewing to coach members toward improved health care behaviors and self-management.

• Provide excellent customer service to new and potential Medicare and Medicaid members and communicate in a professional and respectful manner while responding to inquiries in a timely manner.
• Make outreach calls to members as part of our member engagement and adherence work.

• Establish and maintain cooperative and productive working relationships with internal and external customers.
• Develop and execute plans around projects assigned that involve an outreach to a member to prevent a disruption in their Medication Therapy.
• Provide support in Medicare STARS and HEDIS projects related to STARS.
• Support and help develop projects aimed at improving the member’s experience of care with the health plan.
• Make appropriate referrals for care coordination when needed.
• Maintain and follow up on a panel of members to ensure adherence and assist in removing any medication adherence barriers they may have.

Pharmacy Benefits Administration

• Provide customer service and claims processing as it relates to the pharmacy benefits administration.

• Educate members, providers, pharmacies and CareOregon staff about the CareOregon formularies and pharmacy benefit policies.
• Create and produce documents and spreadsheets for PBM system platforms such as RxClaim.

Operational Support

• Assist with variety of projects, (i.e. letter communication(s) to members and providers, etc.).

• Support Pharmacy department staff with meeting arrangements and administrative tasks as needed.
• Retrieve documents, reports and records if needed for unit activity and functions.
• Assist Supervisor and Leads in updating staff resources (Manuals, SOPs, P&Ps).
• Create reports from QNXT, SharePoint, SAS registry or other systems as assigned.
• Assist in unit preparation for regulatory oversight and review as assigned.
• Locate, assemble, edit and summarize material, information and data as requested.
• Provide support in Medicare STARS and HEDIS projects related to STARS
• Perform member and provider outreach as it relates to care coordination, adherence and other initiatives improving STARS performance or member experience.
• Support the Regional Care Team pharmacists with medication claim validations, scheduling of member appointments with pharmacists, physicians, RCT team members and other applicable stakeholders
• Use spreadsheet software (MS Excel) to produce documents and spreadsheets and PBM system platform such as RxClaim.
• Perform rejected claim reviews as assigned to assist with care coordination

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Knowledge, Skills and Abilities Required

• Knowledgeable with Medicare STARS
• Strong understanding of the concepts of managed care
• Strong understanding of care coordination in population health within the managed care setting
• Proficient in the use of medical terminology and HIPPA requirements
• Intermediate to advanced knowledge of ICD10, HCPCS and CPT codes
• Knowledgeable of PBM system platforms, QNXT, SharePoint, Collective, and case management software
• Ability to use computer software for word processing, data entry and electronic mail
• Ability to use Microsoft Office Suite, including ability to accurately enter and manipulate data using Excel (i.e., formulas, pivot tables)
• Excellent attention to detail and accuracy
• Strong record keeping skills
• Ability to effectively manage multiple tasks
• Ability to use good judgment, personal initiative and discretion to perform job responsibilities
• Ability to be flexible and adaptable
• Ability to work autonomously
• Excellent writing, listening and verbal communication skills
• Excellent customer service skills, focus and a positive attitude
• Ability to diffuse stressful situations with humor and tact
• High level of interpersonal maturity/skills and emotional/social intelligence
• Ability to work in an environment with diverse individuals and groups

Physical Skills and Abilities Required

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

• Minimum 3 years’ experience required in a medical front office, Pharmacy or Pharmacy benefits administration within a health insurance plan
• Experience with Medicare STARS work

Preferred:

• Experience with PBM system platforms, Excel, health plan data systems, such as QNXT, SharePoint, Collective, and case management software

Working Conditions

• Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):

• Inside/office Clinics/health facilities Member homes

• Other_________________________________________

• Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
• Equipment: General office equipment
• Hazards: n/a

#Li-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.