Pharmacy Quality and Medication Adherence Outreach Advisor

Martin’s Point Health Care • Portland, ME

7d

About The Position

The Pharmacy Quality Advisor will support focused efforts and initiatives to drive improvement for our Medicare beneficiaries. These efforts will be focused on Pharmacy related to HEDIS and CMS Star measures. The specialist will conduct member outreach, monitor adherence data, and coordinate with internal and external partners to support quality improvement initiatives. This role will also collaborate closely with pharmacists, providers, and care management teams to improve patient outcomes, reduce hospitalizations, and enhance quality performance measures.

Requirements

• High school diploma or equivalent required.
• 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
• 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
• 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

Nice To Haves

• Associate’s or bachelor’s degree in healthcare-related field preferred.
• Certified Pharmacy Technician (CPhT), Medical Assistant, or similar clinical experience preferred
• Prior experience or exposure to pharmacy or managed care pharmacy preferred
• Experience in quality management or compliance roles strongly preferred
• 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.

Responsibilities

• 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).
• 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.

Benefits

• Martin's 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.
• certified as a "Great Place to Work" since 2015.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED