Description

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security.  Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina.  In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.

Job Summary:

• Deliver Medication Therapy Management services, including but not limited to, Comprehensive Medication Reviews and Targeted Interventions to assess appropriateness of all medications, identify barriers to adherence, and optimize medication therapy.
• Assist with managing medication costs through cost-effective interventions which may include, formulary or therapeutic interchanges, pill splitting opportunities, and assessing unnecessary or duplicate medication therapies.
• Responsible for part D Star Ratings including adherence, CMR, statins in diabetics, and others as needed.
• Manage team of pharmacy technicians and customer service representatives and outbound call effort to improve part D Star Ratings and ensure that team is working efficiently and effectively towards individual and company goals.
• Reports on Star D initiatives to management and progress towards goals as well as production from team, including CMR completions.
• Speaks to HealthCare members on a daily basis regarding adherence and other pharmacy initiatives.
• Solves Rx claim issues with pharmacy providers/provider representatives
• Attends regular staff meetings.
• Assists with mentoring of new team members.
• Completes assigned work plan objectives and projects on a timely basis, meeting production expectations.
• Supports internal team members regarding part D questions, grievances, and CTMs.
• Maintains professional relationships with provider community and internal and external customers.
• Always conducts self in a professional manner.
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Pharmacy Director and/or medical directors regularly, as necessary.
• Complies with required workplace safety standards.

Knowledge/Skills/Abilities:

• Expertise in Medical /pharmacy terminology, drug nomenclature, basic pharmacology, speaking to members about medication adherence, working with providers and pharmacies to assist in procurement of medications for members, quality initiatives, and pharmacy laws and regulations.
• Knowledge and understanding of the Core Elements of MTM services 1) Medication Therapy Review Comprehensive and Targeted, 2) Personal Medication List (PML), 3) Medication-Related Action Plan (MAP), 4) Interventions and Referrals, and 5) Documentation of Services and Follow-up
• Excellent Listening Skills present a warm, friendly, and empathetic demeanor demonstrating active listening techniques
• Clear and Concise Communication Skills able to articulate information, both verbally and in writing, in a clear and concise professional and grammatically correct manneConsistent Professional Demeanor maintain professional attitude and behavior at all times
• Excellent Interpersonal Skills demonstrate empathy with patients and family members in tone, language, questions and demonstrate patience, caring, sensitivity, empathy, and cultural competency throughout job responsibilities
• Exceptional Interviewing Skills able to probe and question patients or health care providers to extract information to understand concerns and needs
• Conflict Resolution Skills able to defuse potential customer or patient conflict utilizing the appropriate tone, support, questions or counsel and respond in a supportive manner
• Maintain Licensure maintain active pharmacist licensure
• Computer/Technology Competency:
• Proficient in use of Microsoft Word, Excel, and Outlook
• Able to multi-task using multiple computer databases/platforms/applications
• Understanding of managed care pharmacy principles and insurance coverage issues.
• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Knowledge of applicable state, and federal regulations.
• Ability to take initiative and see tasks to completion.
• Computer Literate (Microsoft Office Products).
• Excellent verbal and written communication skills.
• Ability to abide by policies.
• Ability to maintain attendance to support required quality and quantity of work.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Main Accountabilities:

• Working with Pharmacy Team to ensure successful Adherence Outreach and MTM Program for members
• Managing team of pharmacy technicians and customer service representatives to ensure Star Rating goals are met.

Qualifications:

• Doctor of Pharmacy Degree
• Minimum of 2 years’ experience in Medication Therapy Management and Star Ratings for Medicare
• Minimum of 2 years’ experience in managing pharmacy technicians and other personnel
• Required Licensure/Certification: Active license in good standing as a pharmacist with State Board of Pharmacy