Job Description

PerformRx;is a pharmacy benefits manager (PBM) dedicated to clinical culture, boutique service, and holistic solutions. Our mission is to help clients, providers, and members use effective medication therapy to improve health and wellness. For over two decades, our focus has been on providing optimal service through a clinical culture that seeks to provide members with high-quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees - more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians - and in the services we provide. PerformRx **;** is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies. **Responsibilities:** + Perform comprehensive medication therapy reviews to identify & resolve medication-related problems + Target members for interactive consultations based on a variety of risk stratification scenarios + Perform interactive consultations, responding to questions or providing clarification for requests generated regarding medication therapy management (MTM)/drug therapy management (DTM) programs + Present all relevant DTM/MTM program materials to P&T Committees, as well as any other internal or external review required by the assigned Plan + Handle calls and correspondence from providers; respond to inquiries and complaints. ;Document calls in the inquiry tracking system. ;Using established protocols, ensure resolutions provided are presented clearly and accurately. ;Receive escalated calls that cannot be clinically resolved by first-level intervention; research, resolve, and respond to provider clinical inquiries regarding DTM. + Support Fraud and Abuse-focused program oversight. Communicate with the appropriate teams about any suspected fraud discovered.;Recommend a course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards. + Serve as second-line contact for all ACFC pharmacy-related issues. ;Ensure internal changes that may affect network services are reflected in the claims processing system. + Coordinate with team, internal departments, and external clients on projects or other identified issues. + Maintain a balance of productivity, quality, and timeliness of job accountabilities. ;Participate in department self-audit procedures for ongoing evaluation of services. + Assist in the training and coordination of pharmacy students and new Pharmacist staff + Perform other job-related duties and projects as assigned ; **Education/Experience:** + Current pharmacy license required; Commonwealth of Pennsylvania preferred; + Pharm.D. preferred + Minimum **two (2) years** of direct patient contact and clinical pharmacy experience required; + Minimum 1 year of current/recent experience in a managed care environment preferred;; + MTM/DTM certificate training preferred + Knowledge in pharmacy practices, procedures, and precedents; ability to read and understand pharmaceutical information; + Proven ability to write technical articles, position papers, and draft presentation documents + Strong clinical knowledge and the ability to make sound clinical judgments + Strong research and analytical ability + Ability to extrapolate data and present research results + Ability to handle multiple priorities and projects independently + Ability to present ideas and findings in a classroom setting + Effective communication (listening, verbal, and written), interpersonal, and organizational skills + Proficient PC skills in a Windows-based environment + Ability to quickly troubleshoot concerns of Providers and handle escalated situations + Demonstrates knowledge of Federal & State laws/regulations regarding provisions of pharmaceutical services;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ; Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we would like to connect with you. Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at **Diversity, Equity, and Inclusion** At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. **Our Comprehensive Benefits Package** Flexible work solutions include remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO) including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more. \#SP As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

Job Tags

Remote work, Flexible hours,

Similar Jobs