CVS Health
Spartanburg, South Carolina, United States
MTM Technician FT- 1269706BR
Posted over 1 month ago · Full time
Job Description
Job Description
Job Summary:
CIC support staff is responsible for identifying and/or initiating MTM cases for eligible patients as the primary task. Position is also responsible for assistin gin the resolution of Patient Specific Therapeutic Interchange (PSTI) or rejected clinical claims management (Prior Authorizations and Covered Alternative Recommendations)
Key Responsibilities:
MTM:
* Monitor and complete eligible MTM cases available in Outcomes/ C2W
* Maintain accuracy in MTM work with minimal errors
* Track/Reprot MTM opportunities as requested
* Follow all applicable government regulations including HIPAA.
* Display behavior which exemplifies employee code of conduct guidelines.
* Other duties as assigned; Job duties may vary by location
* Cross train for coverage of other positions in the CIC
Secondary Responsibilities:
Prospective Intervention on Rejected Clinical Claims and PSTI Issues:
* Monitor CIC and operations queues for rejected claims requiring intervention
* Make appropriate interventions to obtain new order or Prior Authorization (PA) as directed by a CIC pharmacist
* Reconcile responses in CIC queue
* Scan and send new or authorized orders to the appropriate destination
* Track all claim detail, activity, and outcome, as directed
* Review relevant CIC reports and handle accordingly
* Generate PSTI orders, checking for coverage and compliance with Omnicare directives
* Scan and send new or authorized orders to the appropriate Omnicare pharmacy, according to Policy and Procedure
* Process all PSTI responses
* Routinely resend PSTI requests without a response according to Policy and Procedure
* Scan and electronically store all approved PSTI orders
* Cross train for coverage of other positions in the CIC
* Follow all applicable government regulations including HIPAA.
* Display behavior which exemplifies employee code of conduct guidelines.
* Other duties as assigned; Job duties may vary by location.
Required Qualifications
* South Carolina Pharmacy Technician Registration and National Certification (PTCB).
* Previous experience working on MTM cases
* Must be flexible with regards to work schedule
Preferred Qualifications
* Long term care or other medical environment, but not required
* Experience working in Outcomes and Mirixa
Education
High School Diploma or equivalent degree
Business Overview
It’s a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team or calling 877-805-9511.
If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com. For technical issues with the Virtual Job Tryout, contact the Modern Hire Help Desk at 1-877-451-1695 or cvs_support@modernhire.com.
Job Summary:
CIC support staff is responsible for identifying and/or initiating MTM cases for eligible patients as the primary task. Position is also responsible for assistin gin the resolution of Patient Specific Therapeutic Interchange (PSTI) or rejected clinical claims management (Prior Authorizations and Covered Alternative Recommendations)
Key Responsibilities:
MTM:
* Monitor and complete eligible MTM cases available in Outcomes/ C2W
* Maintain accuracy in MTM work with minimal errors
* Track/Reprot MTM opportunities as requested
* Follow all applicable government regulations including HIPAA.
* Display behavior which exemplifies employee code of conduct guidelines.
* Other duties as assigned; Job duties may vary by location
* Cross train for coverage of other positions in the CIC
Secondary Responsibilities:
Prospective Intervention on Rejected Clinical Claims and PSTI Issues:
* Monitor CIC and operations queues for rejected claims requiring intervention
* Make appropriate interventions to obtain new order or Prior Authorization (PA) as directed by a CIC pharmacist
* Reconcile responses in CIC queue
* Scan and send new or authorized orders to the appropriate destination
* Track all claim detail, activity, and outcome, as directed
* Review relevant CIC reports and handle accordingly
* Generate PSTI orders, checking for coverage and compliance with Omnicare directives
* Scan and send new or authorized orders to the appropriate Omnicare pharmacy, according to Policy and Procedure
* Process all PSTI responses
* Routinely resend PSTI requests without a response according to Policy and Procedure
* Scan and electronically store all approved PSTI orders
* Cross train for coverage of other positions in the CIC
* Follow all applicable government regulations including HIPAA.
* Display behavior which exemplifies employee code of conduct guidelines.
* Other duties as assigned; Job duties may vary by location.
Required Qualifications
* South Carolina Pharmacy Technician Registration and National Certification (PTCB).
* Previous experience working on MTM cases
* Must be flexible with regards to work schedule
Preferred Qualifications
* Long term care or other medical environment, but not required
* Experience working in Outcomes and Mirixa
Education
High School Diploma or equivalent degree
Business Overview
It’s a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team or calling 877-805-9511.
If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com. For technical issues with the Virtual Job Tryout, contact the Modern Hire Help Desk at 1-877-451-1695 or cvs_support@modernhire.com.
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