Pharmacy Member Outreach Rep

UHS•McAllen, TX

3d•Remote

About The Position

Prominence Health seeks a motivated and patient case-focused individual to join our Member Outreach Pharmacy Team. The Member Outreach Pharmacy Representative is the liaison between Prominence Health Plan, its members, and contracted providers. The main focus of this position is contacting Prominence Health Plan members by phone to inform and educate them on the health insurance offerings, products, or services, as well as respond to inquiries and assist with quality improvement. In addition, this individual will serve as a lead to resolve drug-related care gaps during telephonic member outreaches. This individual also facilitates the development of the outreach program and serves as the primary contact, offering education, technical assistance, and problem-solving as necessary. By performing outreach activities, the Member Outreach Specialist will identify quality insufficiencies and consult with the department and company's leaders on quality improvement initiatives and outcomes.

Requirements

High School diploma or equivalent required
Exceptional customer service skills, serving patient needs over the phone.
Understanding of health plan departments and functional areas for problem resolution
Understanding of current state laws pertaining to pharmacy dispensing
Comfortable collecting and tracking performance metrics and managing the team to certain performance expectations
Strong analytical skills
Attention to detail
High level of energy
Good computer skills (Excel, Adobe, Word, Outlook, etc.)
Ability to effectively communicate in English, both verbally and in writing.
Utilizing sound drug knowledge to assist patient questions over the phone effectively
Knowledge of medical terminology
Proficient in Microsoft Office skills.
Enjoys working in both individual and team settings
Problem solver – enjoys problem-solving
Self-starter, resourceful, and able to execute projects in a fluid and fast-paced environment
Good communication and relationship skills
Ability to utilize technology and work within multiple software programs

Nice To Haves

Current and valid state licensure as a pharmacy technician is preferred
Current PTCB license preferred
3+ years' experience in making outbound calls to members and or patients preferred
3+ years' in retail/community pharmacy preferred
Written and oral fluency in Spanish is preferred

Responsibilities

Contacting Prominence Health Plan members by phone to inform and educate them on health insurance offerings, products, or services.
Responding to member inquiries.
Assisting with quality improvement initiatives.
Serving as a lead to resolve drug-related care gaps during telephonic member outreaches.
Facilitating the development of the outreach program.
Serving as the primary contact, offering education, technical assistance, and problem-solving.
Identifying quality insufficiencies through outreach activities.
Consulting with department and company leaders on quality improvement initiatives and outcomes.