Especialista De Programas Clinicos En Farmacia

MCS Health; San Juan (PR); On-site; USD 65,000 - 85,000; Full time

Job summary

MCS Health in San Juan, Puerto Rico, is seeking a Registered Nurse to support Pharmacy Quality Clinical Programs, including MTMP and diabetes interventions. The role emphasizes patient education, medication reconciliation, and collaboration with providers to improve outcomes.

Responsibilities include conducting CMRs and TMRs by phone, managing post-discharge reconciliation, and ensuring adherence to statin and opioid-benzodiazepine safety measures. PR nursing license required.

Qualifications

• Bachelor's degree in Nursing Science is required.
• A valid Nurse & Association Nursing Professionals of Puerto Rico license and registration is required.
• Minimum 3 years of experience in health care or health insurance settings.

Responsibilities

• Conduct telephone interventions for MTMPs, including CMRs and TMRs, and document recommendations.
• Perform medication reconciliation to support diabetes management and HbA1c control.
• Educate prescribers and beneficiaries on COB, SUPD, and SPC guidelines and safe pharmacotherapy.

Skills

Nursing

Quality programs

Spanish

English

Education

Bachelor's degree in Nursing Science

Job description

Regular

Exempt

GENERAL DESCRIPTION:

Responsible for working with Pharmacy Quality Clinical Programs, including Medication Therapy Management Program (MTMP: Comprehensive Medication Review (CMR) & Targeted Medication Review (TMR)), Diabetes Program Medication Reconcilliation Intervention, Specialty Program MD Intervention, Star Measure Concurrent use of Opioids and Benzodiazepines (COB) Patient & MD Interventions, Star Measures Statin Use in Patients with Diabetes (SUPD) & Statin Therapy for Patients with Cardiovascular Disease (SPC) MD Intervention, Medication Reconciliation Post Discharge (MRP), among other duties as needed to comply with regulations and internal department projects.

ESSENTIAL FUNCTIONS:

• Works on telephone interventions with beneficiaries identified for annual Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs) to ensure that beneficiaries increase their knowledge and make optimal use of their medication therapies, improve medication adherence, reduce the risk of adverse events, among others, through proper documentation with recommendations in action plans based on findings for both Medicare Lines within the Company and it´s line of businesses.
• Works on telephone interventions with beneficiaries identified for medication reconciliation addressing the management and control of HbA1c, the prevention or delay in the development of complications related to Diabetes and the improvement and management of healthy lifestyles for a better quality of life.
• Manages interventions with recommendations for providers that promotes switching medications to biosimilar and/or interchangeable alternatives, generic medications, consolidation of medications, substitutions to preferred alternatives in step therapies, among others, under the Specialty Program.
• Provides education to prescribers and beneficiaries that are identified every month in the Star Measure Concurrent Use of Opioids and Benzodiazepines (COB) to ensure safe and clinically appropriate treatments, reducing therapy associated risks.
• Makes clinical intervention calls ensuring compliance with the Statin Use in Patients with Diabetes (SUPD) & Statin Therapy for Patients with Cardiovascular Disease (SPC) guidelines about the use of statins in beneficiaries that are identified as non compliant every month to educate and assist prescribers to obtain a prescription claim.
• Works the medication reconciliation post-discharge for the Company´s lines of business daily to ensure compliance with established processes.
• Channels or refers any situation requested by a beneficiary or provider to ensure quality of service.

ADDITIONAL FUNCTIONS:

• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor's degree in Nursing Sciences. At least three (3) years of experience in the health care industry, or health insurance plans, physicians' offices, or hospitals, preferably handling clinical or quality programs.

Certifications / Licenses: A valid Nurse & Association Nursing Professionals of Puerto Rico license and registration is required.

Other: N/A

Languages:

Spanish – Intermediate (comprehensive, writing and verbal)

English – Intermediate (comprehensive, writing and verbal)

"We are an Equal Employment Opportunity Employer and take …".

MCS Healthcare Holdings, LLC. (MCS)is an Equal Employment Opportunity Employer and take …".