Pharmacy Quality and Medication Adherence Outreach Advisor

Join Martins Point Health Care - an innovative not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force ofpeople caring for people Martins Point employees are on amission to transform our health care system while creating a healthier community. Martins Point employees enjoy an organizational culture of trust and respect where our values - taking care of ourselves and others continuous learning helping each other and having fun - are brought to life every day. Join us and find out for yourself why Martins Point has been certified as a Great Place to Work since 2015.

PRIMARY DUTIES AND RESPONSIBILITIES

Employees are expected to work consistently to demonstrate the mission vision and core values of the organization.

• Performs routine audits of pharmacy operations prior authorization requests and appeals processes to ensure accuracy and compliance with federal state and accreditation regulations (e.g. NCQA).
• Adheres to HIPAA DoD CMS and all state federal departmental and organizational policies to ensure patient privacy and compliance.
• Analyzes claims and utilization data to monitor performance metrics and track key quality indicators (e.g. HEDIS Medicare Stars measures).
• Conducts strategic outreach to members to identify barriers to adherence and assist with resolution.
• Tracks trends presents and reports common adherence barriers and member feedback to inform quality improvement efforts to health plan leaders (for example quality and CM) and delivery system
• Leads quality improvement projects and initiatives using data analysis and root cause analysis to identify and resolve process problems and enhance efficiency and quality.
• Partners with clinical leaders of the health plan and delivery system to develop implement and execute effective medication adherence initiatives and other quality improvement efforts.
• Develops and maintain standard operating procedures (SOPs) work instructions and training materials.
• Develops and manage library of pharmacy related materials.
• Serves as a liaison between providers pharmacists patients and community pharmacies.
• Collaborates with cross-functional teams (clinical IT operations) on quality measures health plan performance and alignment of clinical and operational goals.
• Serves as a resource for formulary prior authorizations and cost-sharing inquiries.

POSITION QUALIFICATIONS

There are additional competencies linked to individual contributor provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

Education

• High school diploma or equivalent required.
• Associates or bachelors degree in healthcare-related field preferred.
• Certified Pharmacy Technician (CPhT) Medical Assistant or similar clinical experience preferred

Experience

• 2 years experience in operations data analysis or program development related to health care
• 2 years experience Managed Care Health Plan and Part D benefits/program experience
• Prior experience or exposure to pharmacy or managed care pharmacy preferred
• Experience in quality management or compliance roles strongly preferred

Knowledge

• Knowledge of Medicare Part D regulations health plan operations Pharmacy Benefit Management operations and best practices preferred
• Knowledge of pharmacy operations medications and chronic disease management
• Experience with Medicare Star Ratings and knowledge of adherence-related measures preferred.

Skills

• Windows Based Computer skills: data entry and word processing ability
• Working knowledge of Microsoft Office products including Word Excel and PowerPoint
• Demonstrated telephone etiquette and positive interpersonal skills
• Strong communication empathy and problem-solving skills

Abilities

• Strong interpersonal skills and ability to collaborate with internal and external clients
• Excellent customer services skills
• Superior written and verbal communication skills
• Ability to be flexible with changing priorities and work in a fast-paced environment
• Applies proactive and innovative solutions to improve process effectiveness when appropriate
• Solid analytical skills
• Ability to reconcile financial reports and data
• Strong mathematical ability
• Knowledge of PBM third party billing pharmacy claims processing and pharmacy data management
• Proficiency in Microsoft Office applications (Word Excel PowerPoint)
• Strong organizational skills
• Self-motivated with ability to manage prioritize and complete multiple projects in a timely fashion with limited supervision
• Takes appropriate initiative while soliciting input/advice
• Ability to handle confidential and sensitive information in a discreet and professional manner

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martins Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process to perform essential job functions and/or to receive other benefits and privileges of employment please contact

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