Excellus Health Plan Inc.
Rochester, NY
Job Description: This position supports the health plan's Personal Care Pharmacy Team by addressing the medication needs of members with multiple chronic conditions and open clinical gaps. In collaboration with departments such as Quality Management, Customer Care, and Care Management, the Personal Care Pharmacist conducts telephonic outreach to optimize disease state management and drive gap closure. Essential Accountabilities: Level I Evaluate medication-related problems such as adverse events, therapeutic duplication, adherence issues, polypharmacy, and untreated conditions. Utilize prescription and medical claims data to develop clinical recommendations that address member-specific barriers and gaps in care. Document, analyze, and report outreach activities, interventions, and outcomes when available. Provide member education and materials on the appropriate use of medications. Resolve member-specific benefit issues and refer to appropriate teams as needed....