Pharmacy Quality Specialist

Overview

• Serve as a Pharmacy Quality Specialist, ensuring quality and compliance in pharmacy operations.
• Work remotely, providing support for Medicare Star and other quality initiatives.
• Engage with members to explain MTM program benefits and schedule pharmacist appointments.
• Verify and update member, provider, and pharmacy information in the MTM platform.
• Coordinate communication efforts, including outbound faxing and follow-ups with healthcare providers.
• Respond to inquiries from providers, members, and pharmacies, escalating issues as necessary.
• Support clinical pharmacists by triaging member needs and requirements appropriately.
• Contribute to quality improvement initiatives, enhancing healthcare delivery standards.

Key Responsibilities & Duties

• Verify and maintain accurate demographic and contact information in the MTM platform.
• Contact members to introduce MTM program benefits and schedule pharmacist reviews.
• Handle inbound and outbound communications with providers, members, and pharmacies.
• Coordinate faxing and follow-up calls with healthcare providers to ensure timely responses.
• Assess member needs, triaging to clinical pharmacists or other areas as appropriate.
• Support Medicare Star and other quality initiatives through proactive engagement.
• Ensure compliance with pharmacy regulations and standards in all operations.
• Collaborate with team members to enhance service delivery and operational efficiency.

Job Requirements

• High school diploma or GED required; active pharmacy technician license preferred.
• Minimum of 3 years experience in a related field; 5 years preferred.
• Proficiency in managing member information and coordinating healthcare communications.
• Strong organizational skills to handle multiple tasks and ensure quality outcomes.
• Ability to assess member needs and escalate issues appropriately.
• Knowledge of Medicare Star and quality improvement initiatives is advantageous.
• Experience with MTM platforms and healthcare provider coordination preferred.
• Excellent communication skills for interacting with members, providers, and pharmacies.