Pharmacy Quality Specialist

Overview

• Provide essential support to pharmacy quality initiatives in a remote, contract-based role.
• Verify and update member demographic, provider, and pharmacy information within the MTM platform.
• Engage members to explain MTM program benefits and schedule pharmacist appointments.
• Respond to inquiries from provider offices, members, and pharmacies, escalating as necessary.
• Coordinate outbound communications with healthcare providers, ensuring timely follow-ups.
• Support Medicare Star and other quality initiatives through effective member and provider interactions.
• Collaborate with clinical pharmacists to address member needs and requirements.
• Contribute to the success of pharmacy quality programs in a dynamic healthcare environment.

Key Responsibilities & Duties

• Verify and update member demographic, provider, and pharmacy contact information.
• Introduce members to the MTM program and schedule pharmacist appointments.
• Respond to calls from provider offices, members, and pharmacies, escalating as needed.
• Coordinate outbound faxing and follow-up calls with healthcare providers.
• Assess and interpret member needs, triaging to clinical pharmacists when appropriate.
• Support Medicare Star and other quality initiatives through member engagement.
• Collaborate with clinical pharmacists to ensure member requirements are addressed effectively.
• Maintain accurate and timely documentation within the MTM platform.

Job Requirements

• High school diploma or GED required; Bachelor of Arts preferred.
• Minimum of 3 years of experience in a related field; 5 years preferred.
• Active pharmacy technician license in North Carolina preferred (PTCB certified).
• Proficiency in managing member and provider communications effectively.
• Experience with MTM platforms and healthcare quality initiatives.
• Strong organizational and documentation skills in a remote work environment.
• Ability to assess member needs and collaborate with clinical pharmacists.
• Knowledge of Medicare Star and quality initiative programs.