Medicare Quality Pharmacy Specialist

The Medicare Quality - Pharmacy Specialist is responsible for conducting high-volume outbound member outreach calls to support Medicare Stars programs.

This position is primarily phone-based with the majority of the workday dedicated to making and receiving calls with Medicare members pharmacies and healthcare providers.

The Specialist plays a key role in improving medication adherence closing care gaps and supporting CMS quality initiatives through member education and care coordination with clinical pharmacists. Success in this role requires strong communication skills attention to detail and the ability to meet daily productivity and quality performance standards in a structured call center environment.

• Conduct high-volume outbound member outreach calls to address medication adherence gaps and improve Medicare Star measure performance (e.g. diabetes hypertension statin).

• Educate members on the importance of medication adherence and assist in overcoming barriers (e.g. transportation concerns setting up refill reminders).

• Assist members in understanding their pharmacy benefits and refer to appropriate internal teams when needed (e.g. Care Management Mail Order Pharmacy).

• Identify and assist in resolving pharmacy billing issues or access barriers impacting adherence outcomes.

• Process medication refill requests and coordinate communication between members pharmacies and providers.

• Identify and transfer members to a license clinical pharmacist to resolve medication-related issues and improve member outcomes.

• Assist in the administration of the Medication Therapy Management (MTM) program which includes scheduling CMRs processing opt-outs and other activities assigned to support program.

• Document all outreach activities accurately and in accordance to departmental standards.

• Meet or exceed daily productivity call volume quality and documentation accuracy targets.

• Ensure compliance with CMS requirements HIPAA regulations and organizational requirements.

• Participate in team meetings and quality improvement initiatives aimed at enhancing Medicare Star Ratings and member experience.

• Support special projects and organizational initiatives as assigned.

Required

• 2 years of pharmacy technician experience (retail managed care PBM mail order specialty or call center)

• Strong verbal communication skills with the ability to effectively engage Medicare beneficiaries.

• Ability to work in a high-volume production-driven call environment with extended time on the phone.

• Demonstrated ability to meet productivity and quality performance expectations.

• Strong organizational skills and attention to detail.

• Basic proficiency in Microsoft Office applications.

Preferred

• Bachelors degree or equivalent

• Active Michigan pharmacy technician license and NABP Certified Pharmacy Technician (CPhT) certificate

• Experience supporting Medicare Stars medication adherence measures

• Experience in Medicare Advantage programs

• Call center or outbound outreach experience

• Knowledge of CMS Stars CAHPS and adherence-related quality metrics

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.