Pharmacy Clinical Programs Specialist

MCS Puerto Rico; San Juan (PR); On-site; USD 60,000 - 90,000; Full time

Job summary

MCS Puerto Rico is seeking a Nurse Quality Programs Specialist to support Pharmacy Quality Clinical Programs, MTMP, COB, SUPD and SPC interventions, and medication reconciliation post discharge. This exempt, regular role focuses on telephone interventions, documentation, and collaboration with providers to improve patient outcomes.

The ideal candidate holds a Bachelor's in Nursing, at least three years in healthcare or health insurance settings, and a Puerto Rico nursing license.

Qualifications

• Bachelor's degree in Nursing Sciences is required.
• At least three (3) years of experience in the health care industry, or health insurance plans, physicians' offices, or hospitals.
• A valid Nurse & Association Nursing Professionals of Puerto Rico license and registration is required.

Responsibilities

• Works on telephone interventions with beneficiaries identified for annual Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs).
• Works on telephone interventions with beneficiaries identified for medication reconciliation addressing Diabetes management and healthy lifestyle.
• Manages interventions with recommendations for providers promoting biosimilar/interchangeable, generic medications and step therapies under the Specialty Program.
• Provides education to prescribers and beneficiaries identified in Star Measure COB for safe and appropriate treatments.
• Conducts clinical intervention calls to ensure Statin Use in Diabetes (SUPD) and Statin Therapy for Cardiovascular Disease (SPC) guidelines are followed.
• Performs medication reconciliation post-discharge for company lines of business daily.
• Channels or refers situations requested by beneficiaries/providers to ensure quality of service.

Skills

Spanish language

English language

Education

Bachelor's degree in Nursing Sciences

Job description

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.

Regular

Exempt

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)

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