Senior MTM Clinical Specialist

JOB SUMMARY

The Clinical Quality Specialist is responsible for real-time associate support, claims oversight and resolution, Quality reviews, support of training/coaching, workforce management support, and data reports to help Clinical Services deliver on targeted results, objectives, and key performance indicators. The Specialist will also perform the duties of a MTM Clinical Specialist which includes supporting MTM services completion and providing outreach to patients to receive MTM services.

Clinical Quality Support

• Support leadership through communicating with team real-time when needs or questions arise. Serve as a point of reference for clinical workflow, clinical outreach, service delivery and claims related questions.
• Support leadership with the first 90 days of employment which may include training, quality assessments, and coaching.
• Oversee the management of MTM claims to ensure proper submissions and resolutions. This includes investigating and resolving claims, such as those in Review and Resubmit queue or rejected claims.
• Partner with Clinical Supervisor and Outcomes Quality Assurance, when appropriate, for analysis and process improvements to maintain quality standards and reduce claim submission issues.
• Support the team in meeting quality expectations by reviewing calls, clinical outreach, service documentation and claims, and by providing feedback/coaching to team members when needed.
• Work with leadership to proactively identify and work to close gaps in quality, knowledge, work efficiencies, policies, and processes.

MTM Clinical Specialist (staffing)

• Perform the essential functions of a MTM Clinical Specialist (MCS) as outlined in job description.

Operations Support

• Support Workforce Management activities, which may include assisting with intraday changes due to scheduled modifications, monitoring of workloads and helping the team maximize resources.
• Assist with data collection and reports, as directed.
• Support Outcomes business objectives such as workflow design and management, clinical content review (from MCS perspective), testing, new project and workflow innovation and support, etc.

KNOWLEDGE & REQUIREMENTS

What is expected of you and others at this level

• Meet the knowledge and requirements of a MTM Clinical Specialist
• Strong clinical knowledge and familiarity of medication-related problems
• Knowledge and understanding of the 5 Core Elements of MTM Services, CMS guidelines, and quality measures
• Demonstrated history of superior-quality performance in MTM services
• Deep understanding of Outcomes claims requirements
• Excellent written and verbal skills; Ability to identify and articulate quality defects objectively and professionally 
• Work style that assigns a sense of urgency, with emphasis on the importance of timeliness, accuracy and accountability
• Maintain a level of persistence and follow-up to ensure that no details are missed
• Excellent organizational skills; Must be able to multitask and work with competing priorities
• Strong problem-solving skills
• Computer/Technology Competency; ability to troubleshoot technology issues
• Ability to lead – create excitement and elevates mood of team; retains composure under stress; has a calming influence; is a team player
• Ability to comfortably interact with all levels of associates in the business unit
• Proficient in MS Office Suite, emphasis Excel
• Travel Requirements: Domestic and/or International, up to <10%

EDUCATION & EXPERIENCE REQUIREMENTS

• Minimum years of work experience: 3 years in MTM, retail or managed care setting.
• Minimum level of education or education/experience: High School Diploma/GED; Active pharmacy technician license in state of residence where required and current National Pharmacy Technician Certification (ExCPT or PTCB)

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee 
to successfully perform the essential functions of this job.

• Frequent sitting in stationary position at a desk
• Occasional standing, walking, stooping, kneeling, squatting, and climbing stairs
• Occasional twisting of body
• Occasional reaching by extending hands and arms in any direction
• Occasional lifting, pulling, or pushing

What’s In It For You?

• Medical, Dental and Vision Plans
• Voluntary Benefits
• HSA & FSA
• Fertility & Family Planning Benefits
• Paid Parental Leave
• Adoption Assistance Program
• Employee Resource Groups
• Flex PTO for Exempt Associates & up to 15 PTO days in first year of employment for non-exempt associates
• 11 Paid Holidays
• Corporate Wellness Program
• 401k Employer Match & Roth Option Available – immediate eligibility

The hiring range for this position is $20.95 to $26.20 per hour. The actual base pay offered will consider candidate’s geographic location, job related knowledge, experience, and skill amongst other potential factors. There may be a bonus or commission, and/or a long-term incentive that will be provided as part of the compensation package, along with medical, financial and/or other benefits, depending on the level and position offered.