In a few words…
What is the role of a Case Manager in the context of a PBM? What do they do? How and who do they help? We’re glad you asked! If you were a Case Manager, you would play a key role in helping carry out Medication Therapy Management (MTM) through direct telephone or face-to-face contact with beneficiaries. As Case Manager, part of your job would be to call beneficiaries who are part of the MTM program and discuss their current, chronical conditions and medication treatments, and helping to assess if the treatment is impacting their health in beneficial ways. Being the Case Manager also means you would provide beneficiaries with important information on how to manage their condition(s) and let them know about alternative drug therapies (bioequivalent) and treatments. In addition, you would be collecting certain data such as medical history, medications, and life-style choice, among other things.
The fundamentals for the job…
- You would be essential in discussing (and updating) medical histories, conditions, treatments, and lifestyles with beneficiaries participating in the MTM program.
- Answer beneficiaries’ questions regarding medication therapies and bioequivalent alternatives, and explain anything else they need help with.
- Teach beneficiaries about the importance of properly following medication indications.
- It goes without saying you will do your best to be engaging, kind, sympathetic and generally an awesome conversationalist (trying to strike a balance between caring, informational and interviewer isn’t as easy as it seems), as well as super well-informed on their condition(s). Ensure the MTM program makes a difference and adds value to their life and health.
- Work with the Health Educator to ensure MTM participants are receiving all the necessary and relevant information.
- Promote medication safety and compliance (anything else wouldn’t be responsible!).
- Ensure CMS Compliance (Clinical).
- Work with cross functional teams to plan and execute clinical projects to deliver the highest quality of service for all clients and partners.
- Be a great source of support, and keep abreast of advances in drug therapies and management of chronic conditions.
The bold requirements…
- Bachelor or Master’s (preferred) Degree in Nursing, plus one (1) year of Nursing / Case Management experience or Advanced Healthcare Degree (preferred). (In lieu of a degree, equivalent relevant work experience may be considered.)
- Current/Active Nursing License is a plus.
- Understanding of PBM Clinical Operations and Medicare Part D is another plus.
- Computer proficiency, knowledge of Microsoft Office products, and Internet experience (the basic digital know-how).
- Knowledge of the geriatric population is yet another plus.
- Knowledge of basic concepts of Therapy Managements such as, but not limited to: Asthma, Diabetes, Hypertension, CHF, Cholesterol, among others.
- Clinical knowledge (a given), customer service focused (you couldn’t fathom any other focus), excellent when providing context, scenarios or explaining situations (presentation skills), you ride changes with grace and help others weather the adjustments, and you are one of the most detail-oriented people this side of the world.
- Must be able to communicate effectively (read, write, speak, daydream, argue, flatter, retort wittily etc.) in English and Spanish.
That something extra we´d love to see…
- Analytical: You value the power of context & enjoy examining the past. You get the present by analyzing (sometimes over-analyzing) events leading up to it. This methodology is super helpful, but can provoke analysis-fatigue in those within earshot. Good thing you’re aware of this.
- Adjustable: You are constructive in the face of difficulties and love the challenge of an ever-changing environment. You are accepting and easygoing but not a pushover, just reasonable in excess.
- Detailed: Nothing gets by you and you rarely forget a thing. When learning some new procedure, you’re the type to take notes. When everyone else is still lost, you’re already at the next steps. Others count on this skill of yours.
- Focused: You take direction, follow through, and make the necessary corrections to stay on track. You prioritize, and then act. The basic super soldier is focused. The garden variety multi-millionaire is focused. Most of us spread our focus on too many things and that’s to our detriment.
- People Person: You are interested in others, and enjoy the challenge of meeting new people and winning them over. You feel rewarded just from breaking the ice and making a connection with another. You probably would excel as a diplomat.