Pharmacy Quality Specialist

Pharmacy Quality Specialist Overview

• The Pharmacy Quality Specialist role focuses on supporting medication therapy management (MTM) programs remotely.
• Verify and update member demographic and pharmacy information within the MTM platform.
• Contact members to explain MTM program benefits and schedule appointments for pharmacists.
• Respond to calls from providers, members, and pharmacies, escalating issues as necessary.
• Coordinate outbound communications with healthcare providers and follow up on responses.
• Support Medicare Star and other quality initiatives through effective coordination and communication.
• Collaborate with clinical pharmacists to triage member needs and requirements appropriately.
• Ensure compliance with pharmacy regulations and standards in all activities.

Pharmacy Quality Specialist Key Responsibilities & Duties

• Verify and maintain accurate member and pharmacy data within the MTM platform.
• Contact members to discuss MTM program benefits and schedule reviews with pharmacists.
• Handle inbound and outbound calls, providing resolutions or escalating concerns.
• Coordinate fax communications and follow-ups with healthcare providers.
• Assess member needs and triage to clinical pharmacists or appropriate departments.
• Support quality initiatives such as Medicare Star ratings through effective program execution.
• Collaborate with team members to ensure seamless program operations and member satisfaction.
• Maintain compliance with pharmacy technician licensing and certification standards.

Pharmacy Quality Specialist Job Requirements

• Bachelor of Science degree required; high school diploma or GED is acceptable.
• Minimum of 3 years of relevant experience; 5 years preferred.
• Active pharmacy technician license in North Carolina preferred (PTCB certification).
• Strong communication skills for member and provider interactions.
• Proficiency in data entry and management within healthcare platforms.
• Knowledge of Medicare Star quality initiatives and MTM program operations.
• Ability to work remotely with reliable internet and communication tools.
• Commitment to maintaining compliance with healthcare regulations and standards.