Shire Jobs

What you’ll doIn a few words…Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…The Pharmacy Benefit Manager Operations and Services team provides high quality services to client and beneficiaries and meets that standard by running services from Medication Therapy Management (MTM), price eligibility, configurations, and beneficiary services to government services and beyond. This team oversees the timely completion of claims reprocessing, liaising with other teams such as Pharmacy, Issue Management, and Technology. They also keep an eye on payment adjustments, client support and audit activities.As an Associate Case Manager, you will be responsible for helping carry out Medication Therapy Management (MTM) and Disease Management (DM) through direct telephone or face-to-face contact with beneficiaries. You will call beneficiaries who are part of the Medication Therapy Management (MTM) and Disease Management (DM) programs and discuss their current, chronical conditions and medication treatments to assess if the treatment is impacting their health in beneficial ways. You will 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 will be collecting certain data such as medical history, medications, and lifestyle choice, among other things.The fundamentals for the job…Discuss and update medical histories, conditions, treatments, and lifestyles with beneficiaries participating in the Medication Therapy Management (MTM) and Disease Management (DM)Answer beneficiaries’ questions regarding medication therapies and bioequivalent alternatives and explain anything else they need help with.Educate beneficiaries about the importance of properly following medication indications.Ensure the Medication Therapy Management (MTM) and Disease Management (DM) programs make a difference and add value to their life and health.Work with the Health Educator to ensure Medication Therapy Management (MTM) and Disease Management (DM) participants are receiving all the necessary and relevant information.Promote medication safety and compliance.Ensure compliance with Centers for Medicare & Medicaid Service (CMS).Work with cross functional teams to plan and execute clinical projects to deliver the highest quality of service for all clients and partners.Stay on the know of advances in drug therapies and management of chronic conditions.What we expect of youThe bold requirements…Associate’s or Bachelor’s degree of Science in Nursing.Current and Active Nursing License.3+ years of work-related experience.Knowledge of basic concepts of Therapy Managements such as: Asthma, Diabetes, Hypertension, CHF, Cholesterol, among others.Excellent oral and written communication skills.We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only).   Nice to haves…Experience related to geriatric population.Understanding of pharmacy benefit manager Clinical Operations and Medicare Part D.Physical requirements…Must be able to access and navigate each department at the organization’s facilities.Sedentary work that primarily involves sitting/standing.At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.