Medicare Quality Specialist Pharmacy
Medicare Quality Specialist Pharmacy
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1 Vacancy
Job Description
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 highlevel 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
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
Ondemand 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
Qualifications
Required
2 years of related experience
Preferred
Bachelors 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 topnotch 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.
Ondemand 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 Grand RapidsDepartment Name
PH Clinical Pharmacy Government ProductsEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8 a.m. to 5 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for NonCorewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drugfree workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an onsite or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
