Fallon Health Managed Care Clinical Medicare Pharmacy Technician -Growing Healthcare Organization - NO NIGHTS NO WEEKENDS in Worcester, Massachusetts
About Fallon Health:
Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.
Brief Summary of Purpose:
Primary responsibility is to provide support for in-home and telephonic medication therapy management and reconciliation program. Responsibilities include facilitating member enrollment into Medication Reconciliation and Medication Therapy Management (MTM) programs. This includes daily review of eligible members, outreach to members to provide an overview of the program and screen for enrollment. Individual is also responsible for assisting Safe Transitions Pharmacist with medication access issues including but not limited to prior authorization and accessibility issues. Position requires ability to collaborate with other members of the Fallon health care team such as case managers and navigators. This position is also responsible for reviewing medical benefits and pharmacy prior authorization reviews as they pertain to members enrolled in MTM programs.
Reviews in-home MTM eligibility files
Conducts telephonic outreach to MTM eligible members to facilitate enrollment
Schedules and coordinates initial and follow-up in-home, facility-based and telephonic MTM appointments
Records prescreening assessment and other communications in CER
Notifies Safe Transitions Pharmacist of member enrollment and appointment date and time
Prepares and sends out enrollment and recommendation letters to members or providers as necessary
Assists with medication access issues related to medical benefit pharmacy prior authorizations
Supports Safe Transitions Pharmacist in improving Fallon Health HEDIS and Star ratings
Inputs data (prior authorizations) into core system
Prepares confidential and special reports as needed
Maintains files and records usually of highly confidential nature.
Answers phones from pharmacies physician’s offices
Contacts pharmacies and physicians’ offices to communicate or obtain information
Works collaboratively and ensures communication with members of the Primary Care Team including but not limited to, medical providers, and members
Represents Fallon Health and the MTM program in a collaborative manner to ensure member needs are met
Maintains and updates software documentation systems per Program workflows
Maintains up to date knowledge of Program benefits and department workflows
High School Diploma or Equivalent
Certified Pharmacy Technician
Valid Driver’s License and Clean Driving Record Required
Two or more years of experience in pharmacy/health services including medical record documentation.
F allon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Fallon Health Vaccination Requirements:
To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Posted Date 1 week ago (3/17/2023 4:57 PM)
Job ID 7234
# Positions 1