Medicare Quality Pharmacy Specialist
Core
Conduct high-volume outbound calls to improve Medicare Star measure performance by addressing medication adherence gaps and coordinating care with members, pharmacies, and providers.
Role type
Senior IC pharmacy outreach specialist (Medicare Stars)
Builds
Member education and care coordination programs for Medicare beneficiaries
Domain
Healthcare / Medicare Quality Programs
Deliverable
client delivery
Required skills
outbound calling, medication adherence management, pharmacy benefits navigation, billing issue resolution, Medication Therapy Management (MTM) program administration, HIPAA compliance, call center productivity
Preferred skills
Michigan pharmacy technician license, NABP CPhT certification, Medicare Advantage program experience, knowledge of CMS Stars metrics
Technologies
Microsoft Office
Responsibilities
Conduct high-volume outbound member outreach calls to address medication adherence gaps; Educate members on medication adherence importance and assist in overcoming barriers; Process medication refill requests and coordinate communication between members, pharmacies, and providers; Identify and transfer members to clinical pharmacists for medication-related issues; Assist in the administration of the Medication Therapy Management (MTM) program; Document all outreach activities accurately; Meet daily productivity, call volume, and quality targets.
Seniority
Mid-level, hands-on IC