Clinical Pharmacy Program Coordinator

Middletown RI 02842

Job Description

This position serves as an internal dedicated clinical resource for assigned health plan clients, supporting Clinical Program's leadership in developing clinical initiatives, managing clinical activities for health plan clients and providing enhanced clinical program oversight. Focuses on supporting internal personnel and providing clinical program support, including data analytics and outcomes review/assessment.
  • Oversees the daily clinical activities for various health plan clients and manage various tasks related to clinical program execution. Ensures clinical goals and objectives are met.
  • Evaluates CMS Star and NCQA HEDIS technical specifications for updates and changes on a recurring basis to ensure clinical programs are being executed to the highest standard.
  • Maintains continuity among clinical team by communicating and documenting program design and execution in accordance with client expectations. Tracks and reports on clinical interventions, and findings of disease management activities.
  • Supports leadership in the development of clinical programs. Work closely with the Clinical Services Centers (CSC) ensuring execution of programs.
  • With support of the Clinical Data team, develops and tracks the appropriate metrics to monitor the quality, and effectiveness of clinical programs.  Develops and enhances current reporting metrics to provide continuous quality improvement efforts.
  • Responsible for communications across all departments; an understanding of the strategic impact of the programs for our clients; and extensive knowledge of how the pharmacy programs integrate with other clinical initiatives.
  • Evaluates and coordinates Clinical Program System updates/enhancements through IT ticketing and queueing systems (JIRA).  Document and review all issues to ensure system functionality is accurate and free of bugs.
  • Coordinates with Data Analytics team to ensure timely and consistent reporting is provided to both internal and external clients.
  • Generate outcomes reporting using outreach activity reports and pharmacy/medical data for direct client deliverables.
  • Reviews productivity and evaluate internal resource allocations to ensure programs are running efficiently.  Audits and ensures quality assurance for all program documentation.
  • Manages and updates program outreach populations and proper segmentation through the use of pharmacy and medical analytics.
  • Supports clinical program processes through interactions with compliance, BI, IT and other third party vendors to ensure program interventions are deployed timely and accurately.
  • Supports clinical account managers in ensuring program requirements and performance guarantees are met to ensure recoupment of program fees.

General Job Information

Title

Clinical Pharmacy Program Coordinator

Grade

18

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

5/6/2019

Date Requisition Created

5/6/2019

Minimum Qualifications

Education

Associates (Required), Bachelors (Required), GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

CPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy

Other Job Requirements

Responsibilities

  • Associate's or Bachelor's degree required.
  • Experience with working on and executing STARs/HEDIS/MTM clinical programs by engaging and/or educating (through conversation, faxes, and mailings) and following up with providers, members, and pharmacies on behalf of external health plan clients.
  • Ability to monitor progress and improvement in treatment rates according to CMS’s and NCQA’s technical specifications for STARs/HEDIS/MTM clinical programs. 
  • Apply CMS’s and NCQA’s technical specifications to both complete and incomplete data sets in order to identify member-level opportunities. 
  • Ability to develop and enhance new stratifications and reporting metrics to provide continuous quality improvement for STARs/HEDIS/MTM clinical programs.
  • Ability to receive assignments in the form of high level objectives and independently establish detailed goals to meet objectives.
  • Strong interpersonal skills.
  • Excellent verbal and written communication skills.
  • Ability to function independently and as a team member.
  • Good organization and time management, with the ability to manage multiple tasks.
  • Proven ability to plan, organize, schedule, direct, control and monitor project activities.
  • Ability to interact at a high level with external and internal clients. 
  • History of consistently high performance.
  • Potential for travel for both internal and external meetings. 

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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