Under the direction of the Pharmacist in Charge, assists in managing and training the Pharmacy Department Team, consisting of Pharmacy Technicians and pharmacy concierge team members. Responsible for overseeing and managing internal operations that directly impact Part D stars, HEDIS, and CMS regulatory compliance, including but not limited to medication adherence, Medication Therapy Management (“MTM”), chronic disease management program (“CCM”), and oversight and monitoring of the Pharmacy Benefit Manager (“PBM”).
ESSENTIAL JOB FUNCTIONS:
Manages Health Plan-specific reports that impact medication adherence, medication reconciliation, and other STARs and HEDIS measures.
This position assists and trains the team in maintaining an elevated level of patient satisfaction by providing patients with exceptional customer service and serving as the liaison between patients, physicians, and pharmacies.
Manages completion of the Pharmacy Department daily, weekly, monthly, and open item activities to ensure seamless pharmacy operations.
Creates training material and provides training to the Pharmacy Department team member as needed.
Assists in managing members' care in our chronic disease management programs through member and/or provider outreach.
Responsible for managing member, provider, and vendor outreach to impact Part D quality initiatives using data entry to track outcomes of all communications and outreach. Collaborates with healthcare professionals of all levels involving patient medications.
Direct member outreach to address adherence gaps by identifying/addressing barriers.
Phone and faxing for Provider office outreach to obtain confirmation of prescription and other required data.
Provides education for the PCP offices and staff for the Part D STAR measures.
Providing support to the clinical pharmacists who are performing Medication Therapy Management for Health Plan members.
Practices discretion and care on a regular basis when working with sensitive/confidential data pertaining to the patient, department, or company.
Numbers & Facts
Location
Pasadena, CA
Skills
Chronic Diseaseunmatched
Clinical Supportunmatched
Compensation and Benefitsunmatched
Content Management Systems (CMS)unmatched
Customer Support/Serviceunmatched
Data Entryunmatched
Disease Prevention and Controlunmatched
Fax Machinesunmatched
Health Planunmatched
Health Plan Membershipunmatched
Healthcareunmatched
Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
Medicationsunmatched
Operations Managementunmatched
Pharmacyunmatched
Quality Assuranceunmatched
Reconciliationunmatched
Regulatory Complianceunmatched
Training/Teachingunmatched
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