Partners Health Plan

Managed Care
South Bend, IN

Activities/Responsibilities  

1.   Complete a disease state management project on diabetes, allergic rhinitis, otitis media, hyperlipidemia, CHF, etc. with development of drug treatment algorithms for physician and staff members to use in daily practice.
2.   Prepare and analyze physician report cards detailing prescribing habits and cost to HMO. (Peer to Peer and drug class comparisons.)
3.   Academic detailing visits to physicians to discuss rationale drug usage and outcomes.
4.   Interface/Problem solve claims or formulary issues with pharmacists, nurses, physicians and patients.
5    Experience how PBMs and HMOs interface and the service PBMs provide to HMOs.
6.   Assist in P and T meeting preparation and evaluations for drug formulary management.
7    Utilize the Power Play program for statistical analysis of drug claims to document use/misuse of drug products.
8.   Collate claim information and complete DUE reports and/or initiate a new DUE.
9.   Participate in quality improvement process and analyze quality issues to prepare plan of action.
10. Document cost savings of pharmacist interventions on physician prescribing behaviors.
11. Learn how the members at the HMO work together to provide services to patients, physicians and employers. Meet with nurse utilization review managers, medical director and CEO.