Pharmacy Quality Specialist

Martin’s Point Health Care•Portland, ME

5d•$23 - $28•Onsite

About The Position

The Pharmacy Quality Specialist supports pharmacy quality initiatives focused on improving medication-related quality outcomes, including Medicare Star Ratings, HEDIS, and other organizational quality measures. Working collaboratively with pharmacists, pharmacy leadership, providers, members, pharmacies, and internal teams, the Specialist identifies and addresses medication-related care gaps through member and provider outreach, data review, intervention tracking, and care coordination. This role has a strong focus on medication adherence and pharmacy quality measures, supporting proactive identification of opportunities and timely interventions to improve member outcomes and organizational quality performance. The Pharmacy Quality Specialist supports initiatives across multiple measures, including medication adherence, statin use, medication safety, and other pharmacy-related quality programs.

Requirements

High School Diploma or equivalent
Active Maine Pharmacy Technician license prior to Martin's Point employment
3 years customer service experience required
Proficiency with Microsoft Office/Excel
Strong communication, organizational, and customer service 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
Self-motivated with ability to manage, prioritize and complete multiple projects in a timely fashion with limited supervision
Ability to handle confidential and sensitive information in a discreet and professional manner

Nice To Haves

Prior experience or exposure to pharmacy or managed care pharmacy preferred
Knowledge of Medicare Part D, Stars, and HEDIS quality measures preferred
Familiarity with medication adherence strategies and population health workflows preferred
Applies proactive and innovative solutions to improve process effectiveness when appropriate
Takes appropriate initiative while soliciting input/advice

Responsibilities

Runs and reviews daily, weekly, and monthly reports to identify members with medication-related care gaps and opportunities associated with Medicare Stars, HEDIS, and other quality measures.
Conducts telephonic outreach to members to identify barriers to medication adherence and support timely access to prescribed medications.
Educates members regarding prescription refills, medication access, pharmacy options, benefit resources, and available assistance programs within the scope of the position.
Conducts outreach to provider offices and pharmacies to support resolution of medication-related quality gaps and facilitate timely interventions.
Supports pharmacy quality measures including Diabetes Medication Adherence, RAS Adherence, Statin Adherence, Statin Use in Persons with Diabetes (SUPD), Concurrent Use of Opioids and Benzodiazepines (COB), and Polypharmacy: Use of Multiple Anticholinergic Medications (Poly-ACH).
Reviews pharmacy claims, medication histories, and other available data to identify adherence concerns, refill opportunities, potential medication discrepancies, and quality measure gaps.
Identify members requiring pharmacist clinical review and appropriately escalates medication-related concerns or interventions requiring professional judgment.
Tracks identified quality opportunities from initial identification through outreach, intervention, follow-up, and resolution.
Performs ongoing follow-up with members, providers, and pharmacies to facilitate closure of identified care gaps.
Documents member, provider, pharmacy outreach and intervention outcomes accurately and consistently within designated systems and tracking tools.
Maintains logs, dashboards, reports, and other tracking mechanisms used to monitor quality measure performance, outreach effectiveness, and intervention outcomes.
Supports targeted campaigns and quality improvement initiatives designed to improve medication adherence and pharmacy quality performance.
Collaborates with pharmacists and pharmacy leadership to identify trends, barriers, and opportunities for improvement based on outreach and quality measure data.
Serves as a liaison between members, providers, pharmacies, pharmacists, and internal departments to facilitate communication and resolution of medication-related quality opportunities.
Assists members in navigating medication access barriers, including refill coordination, pharmacy-related issues, and benefit questions, escalating complex issues as appropriate.
Supports provider-facing initiatives, including preparation of outreach materials, identification of actionable opportunities, and follow-up on pharmacist or provider recommendations.
Participates in pharmacy quality meetings, team huddles, and other interdisciplinary meetings as appropriate.
Assists with special projects and process improvement initiatives related to pharmacy quality, member experience, and medication-related outcomes.
Maintain knowledge of applicable quality measures, workflows, policies, procedures, and regulatory requirements.
Performs other duties as assigned to support pharmacy quality initiatives and organizational goals.