Medication Therapy Management (MTM) Specialist - Remote

Prime Therapeutics; Atlanta (GA); Remote; USD 80,000 - 100,000; Full time

Job summary

A healthcare services provider is seeking a Medication Therapy Management (MTM) Specialist to evaluate and authorize prior authorization requests for medications. You will communicate decisions to healthcare providers and ensure compliance with clinical criteria. Candidates should have a pharmacy technician license, experience in pharmacy, and excellent communication skills. This remote position offers competitive pay ranging from $17.85 to $25.48 per hour based on experience.

Qualifications

• Must have an active pharmacy technician license or registration as per state requirements.
• 2+ years experience in pharmacy or healthcare settings required.
• In-depth knowledge of specialty injectable drugs and health plan management.

Responsibilities

• Evaluate and authorize prior authorization pharmacy requests.
• Communicate decisions to healthcare providers.
• Research and document prior authorization outcomes using pharmacy systems.

Skills

Excellent written and verbal communication skills

Ability to identify and troubleshoot problematic issues

Knowledge of medical terminology

Education

GED or High School diploma

Active pharmacy technician licensure or registration

2+ years Pharmacy experience

Tools

Pharmacy computerized systems

MS Office Product Suite

Job description

Overview

Medication Therapy Management (MTM) Specialist - Remote

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

Responsibilities

• Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists. Researches, resolves and documents prior authorization outcomes in pharmacy system.

• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.

• Escalates requests to Pharmacist when request requires extensive clinical review or denial.

• Monitors telephone system to ensure adequate staffing to maintain client services levels.

• Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices.

• Demonstrates, advocates and reinforces a positive team environment.

• Other duties as assigned.

Education & Experience

• Education Level

• GED

• High School

• Required CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy

• 2+ years Pharmacy

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Additional Qualifications

• Must have an active pharmacy technician licensure or registration in accordance with state requirements.

• If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).

• In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).

• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.

• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).

• Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.

• Excellent written and verbal communication skills.

• Ability to follow clinical criteria and instructions to approve prior authorization requests.

• Minimum of 2 years dispensing or retail experience required, or equivalent internal training will be substituted.

• Ability to identify and trouble-shoot problematic issues.

Preferred Qualifications

Physical Demands

• Must be able to remain in a stationary position 50% of the time. Must be able to "move or traverse"

• Must be able to constantly operate a computer and/or other office productivity equipment

• Must be able to hear and constantly communicate information and ideas. Must be able to exchange accurate information

• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $17.85 - $25.48 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [e-mail].