Clinical Pharmacy Specialist, MTM Services

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the MTM Call Center Team within the Pharmacy Services department. This is a full time position working 9:00 am to 5:00 pm with an occasional 10:30 to 7:00 pm shift.  Saturday 9:00 am to 5:00 pm shift is based in a rotation and typically amounts to no more than 5 Saturdays per year.  This is all subject to change based on business needs.  This is a remote position.  

Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity is required.

This position provides pharmacists with the ability to utilize clinical knowledge and pharmacy expertise to recommend and discuss the optimal medication regimen with members. Interventions will include adherence recommendations, medication therapy management, and deployment of innovative clinical programs to enhance member health. These services will be provided in compliance with state and federal regulations, NCQA, standards, the mission, policies and procedures of Health Plan and Pharmacy Department. Individual should demonstrate professionalism and commitment to meet UPMCHP goals and objectives.

Responsibilities:

• Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DPW, CMS and the National Committee for Quality Assurance, specifically as they relate to the expectations of pharmacy operations.
• Participate in trainings, meetings, committees, and work groups both internally and externally as assigned.
• Collaborate with the customer?s internal departments to resolve non-medication related issues and refer members to other resources and/or programs.
• Deliver comprehensive medication therapy management services to optimize a member?s medication regimen including targeted and comprehensive medication reviews.
• Foster and maintain collaborative relationships with internal and external customers.
• Adhere to organizational procedures, including ensuring secure privacy and confidentiality as required by HIPAA employing effective communication methods to maintain call control, documenting appropriate comments, and acting in alignment with all State Regulations and Federal Laws.
• Conduct member, pharmacy, and physician interventions focused on quality measures, including adherence with a goal of resolving medication related issues.
• Ensure compliance with regulatory and accreditation requirements of clinical functions.
• Maintain a solid understanding of the requirements of the Pennsylvania.
• Adhere to call center key performance indicators at all times.
• Complete appropriate documentation regarding interventions.
• Ensures first call resolution to effectively resolve member needs and concerns.
• Provide clinical information to members regarding their medications and answer any pharmaceutical-related questions they may have.
• Teaching and Education Support ongoing training and development programs for Call Center support staff: students and pharmacy technicians.
• Provide innovative and applicable ideas in clinical program development, provider education, MTM and/or improvements in programs and edits that already exist, including both improving operational efficiencies, as well as developing new clinical edits. Implement these new ideas or improvements as approved, while also considering outcomes in all programs.
• Provide clinical assistance support for Pharmacy Technicians when necessary.
• Develop communication materials to providers and members, including discussions regarding adherence, health education, medication adherence, and trend management.