Managed Care Pharmacy Intern

WVU Medicine is seeking a Managed Care Pharmacy Intern to support Medicare Part D quality initiatives and medication management programs. The role involves engaging with members, pharmacies, and prescribers to resolve medication-related issues and improve adherence to chronic medications.

Responsibilities

• Remain current on departmental policies, procedures, formularies, Medicare Part D requirements, MTM protocols, and all applicable regulatory standards
• Adhere to organizational procedures, including secure handling of patient information, privacy and confidentiality per HIPAA, and compliance with State Regulations and Federal Laws
• Receive inbound calls from, and deploy outbound calls to, members, pharmacies, and providers to gather information, address medication-related concerns, and determine when escalation to a pharmacist is required
• Complete calls efficiently and with high quality to meet established call center and Stars program key performance metrics
• Ensure first call resolution whenever possible to effectively address member needs, medication questions, and adherence barriers
• Engage in execution of medication therapy management (MTM), medication adherence, and other quality measure protocols, including member outreach, intervention support, and communication with pharmacies and providers
• Support pharmacists with comprehensive medication reviews (CMRs), medication adherence calls, and other quality measure outreach through pre-work, case preparation, and post-review tasks
• Assist in identifying members with medication adherence gaps and participate in targeted outreach campaigns to improve adherence to chronic medications
• Utilize clinical judgment—within intern scope—to identify potential drug therapy problems and communicate findings to supervising pharmacists
• Maintain accurate, up-to-date patient records and pharmacy system data, ensuring completeness, integrity, and compliance with CMS documentation standards
• Complete timely and thorough documentation of all outreach attempts, clinical interventions, and communication efforts
• Follow up promptly with clinics, providers, pharmacies, and members to resolve outstanding issues or medication concerns
• Participate in departmental quality improvement activities to enhance clinical outcomes, operational efficiency, and Medicare Part D Stars performance
• Support data collection and reporting efforts related to Stars measures, MTM performance, and departmental goals
• Assist with other projects and tasks as assigned to support the pharmacy team and departmental operations
• Assists managed care pharmacists with operational activities and reporting related to the pharmacy benefit manager and administration of the pharmacy benefit
• Collaborate with clinical formulary pharmacists to research and assess medication efficacy, safety, and cost-effectiveness to ensure optimal patient care while managing pharmaceutical budgets

Skills

• Must be actively enrolled in an accredited School of Pharmacy and in good academic standing as a PY2, PY3, or PY4 student
• Must possess current license or trainee license as required by state board where services will be provided: WV: Pharmacy Intern License (Registration) through West Virginia Board of Pharmacy
• Ability to handle and maintain confidential information
• Ability to work cooperatively as a team member with articulate oral and written communication and presentation skills
• Ability to work in a fast-paced and rapidly changing environment with attention to detail
• Ability to work proactively and independently to research and resolve complex issues
• Ability to apply relevant laws, regulations, requirements, and policy standards
• Extensive working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms
• Must be able to communicate effectively verbally and in writing and place high emphasis on customer service

Company Overview

Company H1B Sponsorship