Medicare Quality Specialist Pharmacy

Job Summary

The Medicare Quality Specialist, Pharmacy will assist the Medicare Adherence Pharmacists Team to improve Medicare Star Ratings and CAHPS by making member outreach calls, scheduling appointments, and assisting members with health benefit questions. Additionally, this role will require collaboration with internal and external partners, assisting with the administration of Medicare programs, and other projects assigned to support the Medicare Adherence team.

Essential Functions

• Assist in making member adherence outreach calls and scheduling or transferring members to clinical pharmacist

• Communicate in a concise and effective manner with members, providers, and/or vendors, avoiding jargon to ensure understanding

• Process refill requests through pharmacy or provider

• Assist with correcting pharmacy billing errors, obtaining alternate member phone numbers, and performing data analysis to ensure accuracy and compliance

• Assist members in understanding and navigating their health benefits and refer to appropriate teams (e.g., Care Management, mail order) when necessary

• Assist with the administration of the Drug Management Program (DMP) and the Medication Therapy Management (MTM) Program (e.g., process member opt outs, invoicing, data validation)

• Assist in program audits

• Partner with and participate in meetings with internal and external teams to improve Medicare Star ratings

• Provide high-level, member focused, customer service

• Identify and recommend program enhancements that increase member engagement

• Ensure compliance to CMS requirements and standards

• Other projects assigned by Medicare Quality Manager and/or Director

Qualifications

Required

• 2 years of related experience

Preferred

• Bachelor's Degree or equivalent

• Certified Pharmacy Tech experience

• CPHT Certification

• 2 years of retail pharmacy experience

• Knowledge of CMS Stars, HEDIS, CAHPS, Drug Adherence, and Member Experience

• Experience with Medicare Advantage

• Excellent analytical, organizational, and problem resolution skills

• Microsoft Excel experience

• Ability to work effectively and manage assignments with minimal supervision

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids

Department Name

Clinical Pharmacy Government Products - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application proc