Pharmacy Quality Specialist

Overview

• Provide critical support to pharmacy quality initiatives in a remote capacity.
• Verify member and provider information for accurate MTM platform entry.
• Engage members to explain MTM program benefits and schedule pharmacist reviews.
• Respond to inquiries from providers, members, and pharmacies, escalating as necessary.
• Coordinate outbound communications with healthcare providers for program follow-ups.
• Support Medicare Star and other quality improvement initiatives.
• Work in a collaborative environment to ensure program success.
• Opportunity for contract extension or conversion based on performance.

Key Responsibilities & Duties

• Verify and update member demographic and pharmacy contact information in the MTM platform.
• Contact members to introduce MTM program benefits and schedule pharmacist reviews.
• Handle inbound calls from providers, members, and pharmacies, determining appropriate actions.
• Coordinate outbound faxing and follow-up communications with healthcare providers.
• Assess member needs and triage to clinical pharmacists or other areas as required.
• Support Medicare Star and other quality initiatives to enhance program outcomes.
• Collaborate with team members to ensure seamless program execution.
• Maintain compliance with pharmacy technician licensure requirements.

Job Requirements

• High school diploma or GED required; additional certifications preferred.
• Active pharmacy technician license in North Carolina preferred (PTCB certification).
• Minimum of 3 years of experience in a related field; 5 years preferred.
• Proficiency in handling member and provider communications effectively.
• Experience with MTM platforms and quality improvement initiatives advantageous.
• Strong organizational and multitasking skills in a remote work environment.
• Ability to assess member needs and triage appropriately to clinical pharmacists.
• Commitment to supporting Medicare Star and other quality initiatives.