Responsibilities
- Come and join the RMC Family!
- We have been in the community since 1935.
- Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region.
- Your passion, inspiration, and talents are invaluable to us and our mission to serve others.
- Our facility can provide a place for you to thrive and continue your professional development.
- Quality Healthcare is our passion, improving lives is our reward.
- We are working to change lives and transform the delivery of healthcare.
- Riverside Medical Clinic is the best place to work, practice medicine, and receive care SUMMARY: Provide medication adherence and utilization management support to improve medication adherence rates by identifying barriers that prevent patients from taking medications appropriately and working with care teams to help patients be successful in managing their health.
Qualifications
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions Hours: 8:30am-5:30pm
Qualifications
EDUCATION and/or EXPERIENCE
- Minimum of one year experience in managing HEDIS/Stars measures, specifically managing medication adherence measures within a medical practice.
- Certificates,
- Licenses,
- AND
- REGISTRATIONS: Pharmacy Technician license preferred. Medical Assistant or LVN will be considered with a minimum of 2 years of applicable experience
- Essential
- FUNCTIONS: Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable.
Note
(other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).
1. Telephonic and electronic outreach to patients based on internal, and payer reports, that identify those who may need additional help in managing medications and getting timely refills.
2. Coordinate with members of the patient care team, including providers, pharmacists, nurses, and patient care coordinators to address patient needs related to medication use.
3. With a strong knowledge of pharmacy workflows, insurance plans, and available resources, help patients navigate the complexities of obtaining prescription medications and refills.
4. Support the utilization management team by ensuring proper diagnosis and billing codes are input and verifying the accuracy of the dose.
5. This role will also perform provider outreach to obtain sufficient documentation for coverage determinations as necessary.
6. Enter the appropriate Rx information into the electronic health record.
7. Enter prior authorizations into EHR. If physician approves, send request in interoffice envelope to the physician office, letting them know they need to complete the authorization.
8. Clear open encounters.
9.
Exhibit a professional appearance and attitude.
Adhere to Clinic and departmental policies and procedures This opportunity offers the following: Challenging and rewarding work environment Growth and Development Opportunities within UHS and its Subsidiaries Competitive Compensation About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance.
During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies.
Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S.
States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates.
UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
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