• Amerihealth Caritas Health Plan
  • $29,700.00 -42,410.00/year*
  • Philadelphia , PA
  • Healthcare - Allied Health
  • Full-Time
  • 1103 Market St


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Responsibilities:

* Monitor phone queue and answer calls generated by members/providers. Forward higher complexity and/or clinical member/provider inquiries to DTM pharmacist or DTM Department Manager as appropriate.

* Assign interactive consultation requests to clinical staff for member calls generated through queue.

* Perform and document member general history assessment utilizing the DTM application; document patient comments and inquiries; and review and update member demographics.

* Fax or mail interactive consultations to members and providers which have been completed by clinical staff.

* Follow-up on member/provider outreaches to determine outcomes. Document outcomes in appropriate databases.

* Proficient in use of JIVA and PerformPRO, including: ability to document in both systems utilizing established workflow processes, send letters to members and providers through PerformPRO, and complete items in task queue for both DTM & MTM. Audits mailings prior to delivery.

* Ensure DTM task queue is up-to-date and technician tasks are completed within a timely manner.

* Follow established process workflows for inbound/outbound calls generated within department.

* Administer ASK-12 surveys to members and provide responses to a pharmacist for review. Forward complex cases to a pharmacist for consultation.

* Provide suggestions for system enhancements to appropriate staff to improve process & productivity.

* Administratively supports the DTM Area. Performs varied administrative duties inclusive of handling correspondence, maintaining calendars and mailboxes, scheduling meetings, ordering meals for meetings, preparing agendas and payment of consultants.

* Report issues with PerformPRO application to DTM Department Manager and/or Business Solutions.

* Utilize RxFocus to run general member/provider demographic reports.

* Forward member inquiries outside scope of DTM to appropriate resource utilizing call tree.

* Comply with CMS & URAC MTM/DTM Standards.

Education/Experience:

* High School Diploma or equivalent required; Associate's degree preferred

* Current National Pharmacy Technician Certification (PTCB, NCCT or ExCPT) required

* Minimum three (3) years healthcare experience

* Managed care experience preferred

* Medication Therapy Management training preferred
Associated topics: ascp, blood collection, hematopathology, laboratory, medical lab science, scientist, sterile processing technician, technician lab, technician laboratory, toxicology

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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