Pharmacy MTM & Member Services Specialist

UPMC; Bridgeville (Allegheny County); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Benefits package

Job summary

UPMC Rx Partners seeks a Pharmacy Member to Member Services Rep to support pharmaceutical care through member, pharmacy, and provider interactions. You will handle inbound and outbound calls, assist with comprehensive medication reviews, and maintain patient records while upholding HIPAA and regulatory requirements.

The role emphasizes first-call resolution, quality metrics, and collaboration with pharmacists to ensure safe, effective medication therapies.

Responsibilities

• Complete calls efficiently and with high quality to meet call center KPIs.
• Remains current on departmental policies, procedures, formularies, and regulatory standards.
• Receive inbound calls from and deploy outbound calls to members, pharmacies, and physicians determining the appropriate action and escalation to a pharmacist.
• Supports the pharmacist with completion of comprehensive medication reviews through pre-work up and case preparation.
• Maintain all patient information and records; maintain the pharmacy computer system as required.
• Adhere to organizational procedures, including HIPAA privacy/confidentiality; communicate effectively to maintain call control; document comments; comply with laws.
• Ensure first call resolution to effectively resolve member needs and concerns.
• Engage in medication therapy management interventions with members, pharmacies, and providers.
• Participate in departmental quality improvement activities to improve pharmaceutical care as reflected by metrics.
• Assist in training pharmacy personnel and students; complete documentation of interventions.

Job description

UPMC Rx Partners seeks a Pharmacy Member to Member Services Rep to support pharmaceutical care through member, pharmacy, and provider interactions. You will handle inbound and outbound calls, assist with comprehensive medication reviews, and maintain patient records while upholding HIPAA and regulatory requirements.

The role emphasizes first-call resolution, quality metrics, and collaboration with pharmacists to ensure safe, effective medication therapies.