Managed Care Pharmacy Intern

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Must be actively enrolled in an accredited School of Pharmacy and in good academic standing as a PY2, PY3, or PY4 student.

2. Must possess current license or trainee license as required by state board where services will be provided: WV: Pharmacy Intern License (Registration) through West Virginia Board of Pharmacy

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Remain current on departmental policies, procedures, formularies, Medicare Part D requirements, MTM protocols, and all applicable regulatory standards.

2. Adhere to organizational procedures, including secure handling of patient information, privacy and confidentiality per HIPAA, and compliance with State Regulations and Federal Laws.

3. Receive inbound calls from, and deploy outbound calls to, members, pharmacies, and providers to gather information, address medication-related concerns, and determine when escalation to a pharmacist is required.

4. Complete calls efficiently and with high quality to meet established call center and Stars program key performance metrics.

5. Ensure first call resolution whenever possible to effectively address member needs, medication questions, and adherence barriers.

6. Engage in execution of medication therapy management (MTM), medication adherence, and other quality measure protocols, including member outreach, intervention support, and communication with pharmacies and providers.

7. Support pharmacists with comprehensive medication reviews (CMRs), medication adherence calls, and other quality measure outreach through pre-work, case preparation, and post-review tasks.

8. Assist in identifying members with medication adherence gaps and participate in targeted outreach campaigns to improve adherence to chronic medications.

9. Utilize clinical judgment-within intern scope-to identify potential drug therapy problems and communicate findings to supervising pharmacists.

10. Maintain accurate, up-to-date patient records and pharmacy system data, ensuring completeness, integrity, and compliance with CMS documentation standards.

11. Complete timely and thorough documentation of all outreach attempts, clinical interventions, and communication efforts.

12. Follow up promptly with clinics, providers, pharmacies, and members to resolve outstanding issues or medication concerns.

13. Participate in departmental quality improvement activities to enhance clinical outcomes, operational efficiency, and Medicare Part D Stars performance.

14. Support data collection and reporting efforts related to Stars measures, MTM performance, and departmental goals.

15. Assist with other projects and tasks as assigned to support the pharmacy team and departmental operations.

16. Assists managed care pharmacists with operational activities and reporting related to the pharmacy benefit manager and administration of the pharmacy benefit.

17. Collaborate with clinical formulary pharmacists to research and assess medication efficacy, safety, and cost-effectiveness to ensure optimal patient care while managing pharmaceutical budgets.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to stand and walk short distances for eight or more hours.

2. Frequent bending, stooping, or stretching.

3. Ability to lift 30 pounds and push 50 pounds.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. Some travel may be required to Peak Health for onsite meetings.

SKILLS AND ABILITIES:

1. Ability to handle and maintain confidential information.

2. Ability to work cooperatively as a team member with articulate oral and written communication and presentation skills.

3.

Ability to work in a fast-paced and rapidly changing environment with attention to detail.

4.

Ability to work proactively and independently to research and resolve complex issues.

6.

Ability to apply relevant laws, regulations, requirements, and policy standards.

7.

Extensive working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms.

8.

Must be able to communicate effectively verbally and in writing and place high emphasis on customer service.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center: