Clinical Pharmacy Program Specialist - Remote

$47,500 - $71,240/Yr

Prime Therapeutics - Denver, CO

Full-time - Mid Level

Remote - Denver, CO

Administrative and Support Services

About the position

The Clinical Pharmacy Program Specialist is responsible for managing Medication Therapy Management (MTM) and quality programs, ensuring compliance with CMS requirements and quality targets. This role involves extensive knowledge of medications, disease states, and pharmacy regulations, as well as effective communication with various stakeholders including patients, pharmacists, and clients. The specialist will collaborate with IT and analytics to track metrics, enhance reporting, and support the clinical pharmacy team in delivering optimal pharmaceutical care.

Responsibilities

• Maintain required documentation for all activities and medication recommendations.
• Develop and track appropriate metrics to monitor the quality and effectiveness of MTM and quality programs in collaboration with IT and analytics departments.
• Enhance current reporting metrics to support continuous quality improvement efforts.
• Generate outcomes reporting using outreach activity reports and pharmacy/medical data for direct client deliverables.
• Collaboratively work with clients, providers, and pharmacists to ensure optimal pharmaceutical care.
• Maintain HIPAA standards and confidentiality of protected health information.
• Evaluate and incorporate clinical technical specifications from CMS, NCQA, and PQA to ensure compliance and high standards in MTM and quality programs.
• Generate and enhance clinical outreach materials to maximize program results.
• Assist in meeting company and department goals such as quality improvement activities.
• Ensure outbound calls are made and provide support to pharmacists, pharmacy interns, and technicians performing MTM, clinical, and quality program outreach.
• Ensure compliance with CMS requirements, HIPAA, and Fraud Waste and Abuse regulations.
• Audit MTM and quality program processes for documentation appropriateness and CMS compliance.
• Communicate effectively with the Clinical Pharmacy Team to address ongoing issues or problems.
• Coordinate with multiple vendors to drive results in a timely manner.
• Utilize medical claims expertise to identify new opportunities for MTM and quality programs.
• Generate detailed MTM and quality program outcomes data by analyzing pharmacy and medical data.
• Assist leadership with CMS auditing and HPMS contract submissions.
• Perform other duties as assigned.

Requirements

• Bachelor's degree required with 3 years' healthcare experience, or 7 years of relevant experience in lieu of a Bachelor's degree.
• Ability to develop and operationalize policies and procedures.
• Extremely detail-oriented and organized.
• Ability to work in a high-stress environment and manage multiple complex responsibilities.
• Exceptional written and verbal communication skills.
• Superior analytical, organizational, and problem-solving skills.
• Ability to build consensus and develop partnerships and teamwork.
• Proven experience with Microsoft Office Product Suite and databases.
• Comfortable in an ever-changing environment.
• Ability to think through issues and recommend effective solutions.
• Excellent time-management and multi-tasking skills.
• Analytical proficiency in evaluating pharmacy and medical data.

Nice-to-haves

• CPT - Certified Pharmacy Technician certification preferred.

Benefits

• Health insurance
• Dental insurance
• 401k
• Paid holidays
• Flexible scheduling
• Professional development opportunities
• Tuition reimbursement
• Wellness programs