Job Summary:

• Responsible for clinical research and analysis of program performance of the Medicare Part D Enhanced Medication Therapy Management Pilot Program.
• Specific functions include assisting with the clinical aspects in a new Medicare Part D program. This includes working closely with Medicare Medical Directors in evaluating cases and overall program performance.
• Where applicable, will assist in the preparation of clinical reporting, summaries, and files for internal and external review. Prepare facts, findings, and conclusions based on detailed, thorough clinical research and analysis. Review clinical data to improve program efficiency and effectiveness. Support where appropriate the resolution of clinical cases with the approval of Medical Directors outside the Committee environment.
• The ideal candidate will able to work independently with rapidly changing priorities. Strong communication skills with various levels of staff including program sponsors, coordinators, and leadership.

Essential Functions:

• Independently manages clinical program evaluation, maintenance, and effectiveness processes.
• Optimizes program performance, clinical quality, access to care, and health outcomes.
• Recommends and drives solutions for hospital admissions/readmissions avoidance and medication adherence.
• Coordinates the writing of clinical research documents and the ongoing management of clinical research documents through the clinical program evaluation process; writing of regular clinical effectiveness program summaries; coordination of program logistics/approvals, verification of content to meet institutional, industry, and federal standards.
• Communicates with internal stakeholders, program partners, and/or federal agencies; building budgets to support clinical interventions, collecting regulatory documents, writing informed consent, Assisting with Federal agency reviews and request for documentation.
• Improves policy and expand knowledge of health care and human service systems.
• Enacts, runs, and evaluates programs to enhance delivery and financing of health care and family services.
• Deals with shifts in health care practice, technology, and regulation.
• Creates strategies for institutions, communities, associations, foundations, governments, and people to make health care and human services systems more effective.

Required Qualifications:

• 6+ years related work experience in Clinical research, nursing, or related field.

Required Education:

• Related Bachelor’s degree or additional related equivalent work experience.

Additional Required Qualifications:

• Knowledge of Health Care industry required.
• Medicare and/or Government Pharmacy experience (insurance).
• Experience in Disease Management/Case Management.
• Utilization Management experience.
• Strong research and analytical skills.
• Proven effective communication skills, strong interpersonal/presentation skills and ability to work independently.
• Knowledge of regulatory requirements, (e.g., HIPAA and ERISA).
• PC skills to include MS Word, Excel.

Additional Preferred Qualifications:

• Medication management experience.
• Medicare and/or Government Pharmacy working knowledge.