Job Description

The role of the PRN Medication Case Manager is to serve employers and other entities who self-insure (take on the benefits risk and pay the healthcare claims for) populations of patients. The PRN MCM will work to improve population health through the resolution of drug therapy problems and provide the greatest level of clinical impact to the client populations we serve as measured through creditable DTP resolutions. For this position, the candidate must be fluent in either Spanish or German.

Essential Duties & Responsibilities:

• Call provider’s office to discuss employee or the employee’s dependent’s Drug Therapy Problems (DTPs) that have been identified from Medical and Pharmacy claims. The DTPs include potential adverse reaction between two different medications, potential cost saving alternatives and/or GAPs in medical care as indicated from AdhereHealth's clinical rules platform.

• Partner with the employee’s provider to maintain and/or improve employee’s (or the employee’s dependent’s) health, reducing the number of days missed from work due to acute and chronic illness as well as hospital stays and emergency room visits.

• Make outbound calls to employee’s healthcare provider regarding the employee’s medications with specific focus on potential adverse reactions, potential cost savings to the employees and GAPs in care that have been identified.

• Maintain expected quality measures for calls – Novice MCM (0-3 months in this position) average call length of 5-7 minutes; Intermediate MCM (3-6 months) average call length of 3-5 minutes; Expert MCM (6 months or longer) average call length of less than 3 minutes.

* Fluent in either Spanish or German,.

Leadership Duties (If Applicable)

• N/A

Other Duties & Responsibilities:

• Applying sound judgment required to develop, modify and adapt procedures in order to most effectively meet demands in atypical situations.

• Other duties as required and assigned

Education & Experience:

• Must possess an Associate’s or Bachelor's Degree in Nursing from an accredited school of nursing

• Current unrestricted state LPN/LVN or RN licensure from state of residence.

• LPN/LVN with 10+ years of medical office experience or RN with 5+ years of experience or 3 years of case management, utilization review or employer health benefits experience or equivalent combination of education and experience preferred.

• Experience in interpreting policies and procedures and communicating complex topics effectively

Minimum Physical Requirement:

The PRN MCM will perform his or her work in a home office environment using standard AdhereHealth issued office equipment. Must have a quiet, HIPAA-secure area in which to work and secure high-speed Internet access. The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• Regularly lift and/or move up to 5-10 pounds

• Bend, twist or stoop on a repetitive and continuous basis

• Stand and remain on feet for extended periods of time

• Operate various business instruments, including computers, printers/scanners/fax machines, requiring manual dexterity

• Sit and concentrate for long periods of time to compute, examine, and interpret data

• Read paperwork and computer monitors, requiring visual acuity

Skills:

• Proficient in Microsoft Word, Excel, Outlook and Google and ability to learn new software as needed

• Strong working knowledge of web-based applications (training will be via Webex)

• Strong written and oral communication skills including ability to communicate effectively with all levels of healthcare personnel.

• Strong time-management skills and keen eye to detail

• Ability to deal with all situations in a calm and positive manner