In support of the EmblemHealth Pharmacy Quality program focused on initiatives to meet corporate STAR goals. As part of the Comprehensive Medication Management Program, conduct interviews, develop, facilitate and communicate a plan of care to remove barriers for members who have been identified as having difficulty with medication adherence. Continuously evaluate plan of care and revise as needed. As part of the Medication Therapy Management Program, conduct and document according to CMS standards annual comprehensive medication reviews.
As part of the Comprehensive Medication Management Program:
- Conduct patient medication history reviews face to face and telephonically. Carry a case load of 150 per month.
- Identify barriers to care and work collaboratively with the patient to resolve barriers.
- Recommend changes in drug therapy and lifestyle based on information obtained through patient interviews, interactions, objective monitoring parameters, review of drug profiles and the patient medical record.
- Identify, resolve, and prevent potential and actual medication-related problems including: untreated indications, improper drug selection, subtherapeutic dosage, overdose, failure to receive medication, adverse drug reactions, drug interactions, and medication without indication.
- Provide patient monitoring for evaluating and optimizing patient outcomes, drug utilization and patient compliance, detecting and/or minimizing ADR's, eliminating unnecessary drug use and duplication.
- Provide patient education related to the individual's disease state, including predictable actions, side effects, reasons for proper compliance, and any special instruction.
- Document interactions and care plans within the applicable software.
As part of the Medication Therapy Management Program:
- Deliver and accurately document in a timely manner MTM services to assess appropriateness of all medications, optimize medication therapy, improve clinical outcomes and serve as a drug information resource to patients and interdisciplinary teams. Complete an average of 200 CMR’s per month.
- Coordinate medication reconciliation across the continuum of care by providing comprehensive reviews, addressing adherence concerns, assisting with patient education and monitoring clinical outcomes to help prevent unnecessary readmissions, lapses in care and adverse drug reactions
- Assist with managing medication costs through cost-effective interventions which may include, but are not limited to formulary and therapeutic interchanges, and assessing unnecessary and/or duplicate medication therapies
- Efficiently assess prescribed medication therapy for unnecessary medications, need for additional medications, ineffective medications, inappropriate doses, adverse drug reactions, and adherence concerns
- Determine appropriate interventions to resolve medication ther• Collaborate with prescribers, interdisciplinary care teams, patients and/or caregivers to identify and develop patient-specific disease state therapy goals
- Communicate professionally and discuss/document clinical recommendations/interventions to prescribers and interdisciplinary care teams
- Ensure maintenance and compliance with clinical standards of the CMMP and MTM services provided, and remain up-to-date with clinical knowledge
- Maintain comprehensive knowledge of policies and procedures, and perform in accordance with applicable regulatory and accreditation requirements or standards as they relate to assigned responsibilities and functions
- Aid in the evaluation and maintenance of formulary set-up based on clinical requirements, compliance with regulatory bodies, and P&T rules.
- Other projects/ duties as assigned.apy problems, achieve goals of therapy and prevent new medication therapy problems