Medication Therapy Management Clinician (RN, LPN, NP Required)

Solis Health Plans; Florida; On-site; USD 65,000 - 85,000; Full time

Job summary

Solis Health Plans, Inc. seeks an MTM Clinician to provide comprehensive medication therapy management services via telephone. The role focuses on assessment, optimization, and ongoing management of therapy in line with clinical standards and program objectives.

The MTM Program Clinician will engage patients by phone, document recommendations for prescribers and care teams, and support cost-effective, patient-centered care strategies in a fast-paced health plan environment.

Qualifications

• Active Florida RN, LPN, or NP license.
• 3 years healthcare or related retail experience.
• Bilingual English/Spanish required.
• Knowledge of prior authorization criteria and pharmacy/claims processing.
• Proficient in MS Office and common computer systems.

Responsibilities

• Deliver MTM services including Comprehensive Medication Reviews and targeted interventions.
• Conduct proactive patient outreach to explain MTM benefits and engage patients.
• Receive and respond to patient calls and take action per protocols.
• Document discussions with patients in a web-based application.
• Communicate clinical recommendations to prescribers and care teams.
• Assess medication therapy for appropriateness, safety, and adherence.
• Develop evidence-based interventions to resolve MTM problems.
• Identify adherence barriers and provide patient-specific solutions.
• Provide patient-centered education on chronic diseases and medication regimens.
• Collaborate with Care Management to address HEDIS gaps.
• Assist in preparing educational materials for internal and external use.
• Perform other duties as assigned.

Skills

Bilingual English/Spanish

Prior authorization knowledge

Telephone-based patient communication

Education

Florida Registered Nurse (RN/LPN/NP)

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

Position Summary

The Medication Therapy Management (MTM) Clinician is responsible for providing comprehensive, patient-centered medication therapy management services designed to optimize medication use and promote positive clinical outcomes. The MTM Program Clinician will perform a broad range of MTM activities, including the assessment, optimization, and ongoing management of medication therapy in accordance with established clinical standards and program objectives. MTM services will be delivered to patients through telephonic engagement.

Essential Duties & Responsibilities

To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation; including, but not limited to:

• Deliver MTM services, including but not limited to, Comprehensive Medication Reviews, Targeted Interventions, Adherence Monitoring Interventions, Cost-Effective Interventions, and Transitions in Care.
• Conduct proactive patient outreach to introduce and explain the benefits of the MTM program, while overcoming objections and using persuasive communication techniques to engage patients who may be hesitant or initially unreceptive.
• Receive and respond to incoming patient calls; take appropriate action based off protocols.
• Document all discussions with patients in a web-based application
• Communicate and document clinical recommendations to prescribers and interdisciplinary care teams
• Assess medication therapy for appropriateness, effectiveness, safety, dosing accuracy, unnecessary or missing therapies, adverse drug reactions, and adherence concerns
• Develop evidence-based interventions to resolve medication therapy problems, achieve therapeutic goals, and prevent future issues
• Engage in cost effective medication strategies that support responsible medication utilization.
• Identify adherence barriers and create practical, patient specific solutions.
• Provide patient centered education on chronic disease states and on preventive and therapeutic medication regimens
• Collaborate with the Care Management and Clinical teams to assist in addressing HEDIS gaps
• Works effectively with prescribers, interdisciplinary teams, patients, and caregivers to establish individualized therapy and disease state goals
• Assist in gathering and preparing educational material to be distributed to both internal and external entities
• Performs other duties as assigned

Qualifications & Education

• Active Florida Registered (RN, LPN, NP)
• Requires three (3) years prior experience working in a health care environment or equivalent retail experience
• Prefer three (3) years managed care experience, primary focus on Medicare line of business
• General knowledge of Prior authorization criteria and pharmacy claims processing
• Knowledge of health care performance measurement; HEDIS, CMS Part D Stars ratings strongly preferred
• Clinical experience in medication review
• Excellent verbal and written communication skills
• Commitment to excellence and high standards
• Strong organizational, problem-solving, and analytical skills
• Able to manageprioritiesand workflow
• Demonstrates a high level of professionalism in dealing with confidential andsensitiveissues
• Ability to work effectively, independently and in a team environment
• Ability to deal effectively with a variety of individuals
• Fluency in English and Spanish is required
• Proficiency in computer software (i.e. Microsoft Word, Excel, Power-Point, and Outlook) and the ability to learn new and complex computer system applications (including comfort using short-cut keys/demands)

WORKING CONDITIONS

• The noise level in the work environment is usually moderate
• Interacts with health plan members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances
• This work requires the following physical activities: bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity
• The work is performed onsite at the office
• All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed
• Work schedule is approximate, and hours/days may change based on company needs