Pharmacy Intervention Specialist
PMA Companies

Job Info

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Responsible to review incoming point-of-sale prescription authorization requests; assess and apply evidence-based treatment and jurisdictional guidelines to drug approval process to ensure best practice standards. Develop action plan, effectively communicate with business partners, and facilitate referrals to leverage pharmacy interventions as appropriate.

Responsibilities:

• Assessment of complete medication regimen prescribed against established guidelines
• Working knowledge of Managed Care tools to utilize the right expert for pharmacy intervention
• Proficiency in Pharmacy tools as available through PBM to maximize utilization of program and achieve optimum outcomes
• Monitor prescription regimens on identified claims to ensure dosage and duration do not exceed what is medically reasonable and necessary according to FDA guidelines, treatment guidelines, manufacturing guidelines or weaning treatment plans as established.
• Facilitate Peer Review referrals to obtain expert recommendations on therapeutic alternatives and weaning plans for current medication protocols.
• Facilitate Urine Drug Screen Referrals as per treatment guidelines, review and interpret results for further intervention.
• Recommend or facilitate Drug Utilization Review (Drug UR) to determine medical appropriateness on new prescriptions as jurisdiction allows.
• Apply state Medical Treatment Guidelines relating to pharmacy parameters to maximize jurisdictional opportunity to manage medication use
• Remain alert for red flags such as multiple providers, duplication of ingredients, early refills and trigger appropriate interventions.
• Maintain a strong working knowledge of evidence-based treatment protocols for daily assessment activities.
• Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

Requirements:

• Registered Nurse (RN) license or Licensed Practical Nurse (LPN) required with 5 + years clinical background in pain management, addictions, clinical rehabilitation, medical-surgical, orthopedics, or ER/ICU/CCU nursing
• Expert knowledge and utilization of evidenced based treatment guidelines to establish appropriate medical treatment
• Strong verbal and written communication skills with internal and external customers, vendors, and providers
• Overall qualities: Strong initiative, team player, high energy, organizational skills, detail oriented, problem solving, and analytical skills
• Basic working knowledge of Microsoft office applications required
• Demonstrates independent professional judgment in case work, requiring minimal or no supervisory oversight of service delivery.
• Maintains current knowledge of, and complies with, all regulatory requirements for assigned jurisdictions related to workers' compensation medical management.
• Demonstrates technical proficiency through timely, consistent execution of best-case management practices.
• Communicates effectively, orally and in writing with internal and external parties on a wide variety of claims and account issues.
• Develops case action plans for complex claims and offers realistic recommendations for moving the claim forward.
• Provides a high degree of customer service to clients, including participation in claims reviews, stewardship meetings and similar account-specific meetings.
• Demonstrates computer literacy in the use of email, MS Office Product Suite (i.e. Word, Excel), proprietary PMA systems and internet queries for research.
• Analysis/Judgment: Demonstrates critical thinking skills with sound analysis, judgment and decision making with a focus on attention to detail.
• Planning and Organizing: Demonstrates strong organizational skills with the ability to analyze and balance workload requirements. Effectively prioritizes assignments and utilizes team members to achieve departmental goals.
• Teamwork: Demonstrates personal interaction skills showing consideration for others and awareness of the effects of one's own behavior. Proactively contributes to the organization's service delivery and profitability.
• Collaboration: Works effectively with others to achieve specific goals in order to achieve overall success of assigned projects.
• Initiative: Independently seeks solutions and self-development; anticipates needs of others and offers solutions, develops creative ways to do the job better.
• Technical/Professional Knowledge: Displays understanding of technical knowledge and language of job; knows what next step is necessary to gain favorable outcome. Facilitates expanded knowledge within the team.
• PMA Corporate values: Acts in accordance with the values of passion, accountability, professionalism, teamwork and execution.
• Maintains current RN/LPN licenses and certifications, as necessary. Ensures that all state-required Continuing Education Credits are obtained as needed to maintain license
• Certified Case Manager (CCM); or obtain certification one year from hire
• Other professional certifications considered on an individual basis.

This job has expired.