Quality Improvement - STARS Medication Adherence Specialist 195-1031

JOB SUMMARY:

The Stars Medication Adherence Specialist implements, tracks and supports new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for providers and members in accordance with prescribed quality standards; conducts data collection, tracking and monitoring for key performance measurement activities at the provider and member level. Provides ongoing practice support and sustains the partnership. Improves the understanding and sensitivity to the unique needs of the CommunityCare population. This role spends 100% of time on quality program activities.  

KEY RESPONSIBILITIES:

The Stars and Medication Adherence Specialist contributes to one or more of these quality

improvement functions:

• Makes outbound calls to members and healthcare professionals regarding patient medications, adherence, and barrier removal.
• Conducts chart research and analysis to identify barriers to prescription regimens
• Interacts with healthcare professionals of all levels involving member medications.
• Calls the pharmacy or provider to assist member with medication refills, medication synchronization, or 90-day supply requests.
• Provides feedback and/or solutions on how to improve the medication adherence member experience.
• Performs other duties as assigned and modified at manager’s discretion.

   QUALIFICATIONS:

• Knowledge of medication adherence practices
• Familiarity with State and federal regulations governing healthcare
• Understanding of CMS 5 Star program and requirements. 
• Medicare Advantage and /or medical practice experience preferred
• Proficient in Microsoft Excel
• Successful completion of Health Care Sanctions background check
• Excellent verbal and written communication skills
• Ability to work independently under stringent deadlines

EDUCATION/EXPERIENCE:

• Certification as a Pharmacy Technician with a minimum 12 months of related work experience OR
• A minimum of 2 years of work experience in a medication dispensing/pharmacy setting or call centerrequired
• High School graduate or GED equivalent; College degree preferred or equivalent combination of education and work experience.