Managed Care Coordinator jobs in Pembroke Pines, FL

Position Summary:

Provides high quality and effective assistance to the pharmacy team on various clinical and data driven activities. Such activities will include, but not be limited to patient care, customer relationship management, internal customer service, data gathering, report preparation, assisting in the training of IPPE/APPE students, and other related duties.

Essential Duties and Responsibilities:

1. Conducts patient outreach calls to improve HEDIS outcomes and assists in daily medication therapy management (MTM) calls to eligible members.

2. Address, triage, investigate and resolve customer relationship management (CRM) concerns. Identify concerns that require the clinical pharmacist and direct for review.

3. Assist internal team members with basic pharmacy related questions, such as verifying members’ claims activities for eligibility, addressing weekly comprehensive drug list questions related to medication coverage etc.

4. Assist the clinical pharmacist with grievance and appeals preparations as needed. Assist with prescription related issues identified during clinical rounds.

5. Conduct calls, send faxes to pharmacies, PBM’s and providers offices to assist members and internal teams with medication related concerns.

6. Prepare and send documentation related to MTM and clinical programs to appropriate recipients.

7. Complete assigned reports for pharmacist review as needed.

8. Document all clinical encounters in the appropriate clinical platforms. Documentation should describe patient interactions, problems, resolutions, and referral information (when applicable).

9. Always abide by HIPPA and CCP confidentiality policies. Always HIPAA verify using 2 identifiers when making or receiving calls.

10. Assist in the initial workflow and systems training of IPPE/APPE students from colleges of pharmacy partnered with CCP for these learning experiences.

11. Identify when to escalate concerns to the clinical pharmacist or pharmacy director when there is uncertainty or barriers to addressing a situation.

12. Keep work areas clean and organized.

13. Complete member-related tasks within the same business day whenever possible. Address member concerns in a timely manner.

14. Refer all prescribers (MD, DO, APRN etc.) and customer calls related to medical questions to the Pharmacist.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications:

· Must be a registered certified pharmacy technician for the State of Florida.

· Must have 3 plus years’ experience working as a pharmacy technician in hospital, managed care (preferred) or retail setting with previous hospital or managed care experience.

· Experience in medication therapy management (MTM) activities (preferred) and/or assisting in patient counseling activities.

· Experience in resolving medication claims concerns for members, providers, and pharmacies.

· Proficiency with Microsoft Office products (preferred).

· Experience working with any of the following populations: Medicaid, Medicare, Long Term Care (LTC) or Florida Health Kids (FHK).

· Experience with using pharmacy tools to research and retrieve clinical documents. Comfortable retrieving clinical studies or articles that may be requested by the pharmacist.

· Must be able to type 40- 45 wpm minimum.

Skills and Abilities:

· Good verbal and written communication skills.

· Good organizational skills.

· Good problem-solving skills.

· Ability to adapt to change, organize, prioritize, and multi-task.

· Ability to empathize with members and complete required tasks.

· Computer skills (create documents, reports, organize folders, sort data, etc.)

· Typing skills (at least 45 wpm)

Job Type: Full-time

Pay: $18.48 - $21.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Free parking
• Health insurance
• Life insurance
• Opportunities for advancement
• Paid sick time
• Paid time off
• Retirement plan
• Vision insurance
• Work from home

Physical setting:

• Office

Schedule:

• Monday to Friday

Ability to Relocate:

• Sunrise, FL 33323: Relocate before starting work (Required)

Work Location: Hybrid remote in Sunrise, FL 33323