What are the responsibilities and job description for the Pharmacy MTM Coordinator position at Centene Corporation?
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Pharmacy MTM Coordinator - Remote / WFH
Position Purpose: Coordinate and review the work coming in and out of the department. Utilizes analytical skills to assess validity of data and supports monthly and quarterly departmental reporting initiatives. Under the direction of a pharmacist, assists in the provision of medication therapy management (MTM), retrospective drug utilization review (rDUR) and quality assurance services as mandated by Federal and State laws/regulations. Acts in a limited leadership capacity as a point person for workflow, software, procedure and assignment questions within the department and partners closely with other pharmacy and functional departments on a frequent basis to ensure synergies and cross-departmental effectiveness.
Under the direction of a pharmacist, handles inbound and outbound written and verbal departmental communications.
Coordinates outbound mailing campaigns.
Ensures key departmental processes are captured for tracking and trending purposes,
Coordinates, supports and implements MTM workflow using a variety of technology platforms; and ensures distribution of casework across all programs and lines of business.
First tier point of contact for information gathering in audits relating to MTM's monthly, quarterly and annual validation of data for CMS reporting.
Assists department leadership in monitoring of the hotline phone queue for members and providers.
Engages in drug utilization review (DUR) by supporting the execution of DUR initiatives via meeting preparation, letter campaigns, and telephonic outreach to members/providers.
Coordinates the implementation of retrospective drug utilization review (rDUR) point of sale edits and also ensures appropriate adjudication of rDUR claims via weekly retrospective analysis.
Compiles member enrollment lists for various disease state programs on a daily and monthly basis as necessary.
Gathers and analyzes data to create daily, weekly, and monthly departmental reports as indicated.
Reviews and tracks all aspects of data to be analyzed to produce quality indicators, disease state management programs and medication therapy management services.
Assists with provision of in-service education to technician staff.
Helps prepare training material and maintenance of standard operating procedures.
Assists with training new hires, as well as current employees, to meet department standards and compliance.
Supports leadership and the department on a wide array of MTM related initiatives, tasks and projects related to all aspects of the medication therapy management line of business.
Under the direction of management, prepares presentation documents as indicated for quarterly Quality or Drug Utilization Review committees.
Performs special projects as assigned.
Education / Experience: An associate degree in a related field required or equivalent work experience. Bachelor's Degree in a related field, preferred. Requires 2 years of experience in pharmacy, hospital or operational retail environments. 1 year of experience in managed care experience, preferred.
Licenses and Certifications: Certified Pharmacy Technician (CPhT), preferred.
Working Shift: 11am - 8pm Monday - Friday (EST / Eastern).
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.