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Customer Service Representative - Pharmacy MTM Services

  • Job ID: 024173499
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: RxAnte Cost Center
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $15.88 to $24.98 / hour

Description

UPMC Health Plan is hiring a team of full-time Customer Service Representatives to join our Medication Therapy Management team. This is a Monday - Friday daylight role (with 8-hour shift options between 9:00 a.m. - 7:00 p.m.). The 11:00 a.m. - 7:00 p.m. shift is initially assigned, with the ability to choose the 9:00 a.m. - 5:00 p.m. shift, once additional staff members join the team. Occasional, rotating Saturday shifts are also required (typically, once every other month, depending on business needs). This is a hybrid role with remote/work-from-home privileges, with the potential for some travel to the office for trainings, department needs, etc.

This role will support the provision of pharmaceutical care through member, pharmacy, and provider interactions to discuss and resolve medication-related issues. These services will be provided in compliance with state and federal regulations, NCQA standards, the mission, policies, and procedures of UPMC Health Plan and the Pharmacy Department.

Our employees receive comprehensive benefits and have ample opportunities for growth and advancement.  After joining our team, you will receive extensive pharmacy training which will allow you to provide best-in-class service to our members. 



Responsibilities:

  • Complete calls efficiently and with high quality to meet call center key performance metrics.
  • Remains current on departmental policies, procedures, formularies, and regulatory standards.
  • Receive inbound calls from and deploy outbound calls to members, pharmacies, and physicians determining the appropriate action and understanding the appropriate cases to escalate to a pharmacist.
  • Supports the pharmacist with completion of comprehensive medication reviews through pre-work up and case preparation.
  • Maintain all patient information and records. Maintain the pharmacy computer system as required.
  • Adhere to organizational procedures, including ensuring secure privacy and confidentiality as required by HIPAA, employing effective communication methods to maintain call control, documenting appropriate comments, and acting in alignment with all State Regulations and Federal Laws.
  • Ensures first call resolution to effectively resolve member needs and concerns.
  • Engages in the execution of medication therapy management protocols through interventions with members, pharmacies, and providers.
  • Participate in departmental quality improvement activities, including clinical opportunities as well as operational efficiencies in order to continually improve and evaluate pharmaceutical care as reflected by operational and patient care indicators.
  • Assist in the training of pharmacy personnel and students.
  • Complete appropriate documentation regarding interventions.



Responsibilities:

  • Complete calls efficiently and with high quality to meet call center key performance metrics.
  • Remains current on departmental policies, procedures, formularies, and regulatory standards.
  • Receive inbound calls from and deploy outbound calls to members, pharmacies, and physicians determining the appropriate action and understanding the appropriate cases to escalate to a pharmacist.
  • Supports the pharmacist with completion of comprehensive medication reviews through pre-work up and case preparation.
  • Maintain all patient information and records. Maintain the pharmacy computer system as required.
  • Adhere to organizational procedures, including ensuring secure privacy and confidentiality as required by HIPAA, employing effective communication methods to maintain call control, documenting appropriate comments, and acting in alignment with all State Regulations and Federal Laws.
  • Ensures first call resolution to effectively resolve member needs and concerns.
  • Engages in the execution of medication therapy management protocols through interventions with members, pharmacies, and providers.
  • Participate in departmental quality improvement activities, including clinical opportunities as well as operational efficiencies in order to continually improve and evaluate pharmaceutical care as reflected by operational and patient care indicators.
  • Assist in the training of pharmacy personnel and students.
  • Complete appropriate documentation regarding interventions.

 

Qualifications

  • Completion of High School Diploma or equivalent.
  • Minimum 1 year customer service and/or call center experience.
  • Certified pharmacy technician preferred.
  • Excellent organizational, interpersonal, and communication skills


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct