Medicare Quality Specialist Pharmacy

Corewell Health • Grand Rapids, MI

5d • Remote

About The Position

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.

Requirements

• 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.

Nice To Haves

• 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

Responsibilities

• 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level