This position is responsible for the implementation and oversight of several clinical functions, including: Medication Therapy Management (MTM), retroDUR (rDUR), and pharmacy education. Additionally, this position is the MTM regulatory/legislative subject matter expert (SME) and liaison for the company. This role requires extensive knowledge of medications, conditions, MTM services, MTM platforms and reporting capabilities. Additional responsibilities include communications with pharmacists, interns, and other MTM related providers. Responsible for ensuring all client goals and Centers for Medicare & Medicaid Services (CMS) requirements are being met for the MTM products. Also responsible for developing new products and leading sales efforts and presentations (both virtually and in-person) to sell existing and new clinical products.
Manages the operations of the Medication Therapy Management (MTM) product.
Responsible for all MTM audits and Centers for Medicare & Medicaid Services (CMS) data validation information.
Ensures MTM criteria is appropriate for the client and uploads annual MTM eligibility criteria to Health Plan Management System (HPMS).
Provides account management and client relations to MTM clients.
Accesses, downloads, and analyzes Acumen Patient Safety Reports
Provides final verification of clinical staff work on MTM patients' Comprehensive Medication Reviews (CMRs) via validation of the beneficiary level report (BLR)
Provides constructive feedback on drug therapy recommendations.
Educates and mentors pharmacy students and residents.
Assists sales team in promoting department growth (i.e., via leading presentations) and implementation of new clients.
Speaks at local and national conventions for the promotion of MTM services.
Understands and interprets current clinical practice guidelines ( American Diabetes Association (ADA), American Heart Association ( AHA ) , Joint National Committee (JNC8), American College of Cardiology (ACC), etc.).
Understands and interprets CMS communication and requirements surrounding MTM services.
Builds, develops, enhances, and operationalizes new MTM/clinical products for up-sell opportunities.
Generates proposals, Request for Proposal (RFP) responses, marketing materials, outreach documents, protocols, cost models, and legal contracts for MTM/clinical products/programs.
Other Job Requirements
Responsibilities
Active license to practice pharmacy
PharmD from an accredited College of Pharmacy
Experience working in a CMS-approved MTM program
Ability to develop and operationalize policies and procedures
Ability to work in a high stress environment and manage multiple complex responsibilities
Exceptional written and verbal communication skills
Superior analytical, organizational and problem solving skills
Consensus builder who strives to develop partnerships, teamwork and good working relationships
Proven experience working with standard computer applications including word processing, spreadsheet, and databases
Must be approachable, polite and have an impeccable work ethic, supporting the company's culture
General Job Information
Title Director of Clinical Programs & MTM
Grade 30
Work Experience Pharmacy
Education PharmD (Required)
License and Certifications - Required PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy
License and Certifications - Preferred
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.