Pharmacy STARS Specialist (52645)

WHO WE ARE:

GlobalHealth is a fast growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

WHO YOU ARE:

Performs tasks associated with quality initiatives to improve member care. Ensures the effective management of medication adherence, including data entry, member status monitoring, call tracking, and telephonic member/provider outreach.

ESSENTIAL JOB FUNCTIONS:

• Supports and maintains outreach initiatives with members and providers.
• Effectively educates Medicare members to enhance patient compliance and support quality metrics.
• Performs accurate data entry in the outreach tracking system.
• Reviews and maintains prescription records to identify and confirm medication adherence.
• Effectively educates providers on quality metric guidelines to enhance patient compliance on an as needed basis.
• Maintains a strong working knowledge of STARS measures set by CMS performance standards.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned.

EDUCATION AND EXPERIENCE:

• High School diploma or equivalent required
• Current Certified Pharmacy Technician or one year of experience with a health plan, medication adherence or within a quality department or pharmacy.

KNOWLEDGE, SKILLS AND ABILITIES:

• Computer literate and familiar with Microsoft applications (Word, Excel)
• Basic electronic health record knowledge and ability to quickly learn new software
• Detailed knowledge of quality performance measures and clinical health care
• Strong organizational and time management skills
• Strong verbal and written communication skills

WORK ENVIRONMENT:

This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. This is a largely sedentary role; however, some filing is required, which would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. May need to lift up to 25lbs.

TRAVEL:

Travel is not required for this position

SUPERVISORY RESPONSIBILITY:

This position has no supervisory responsibilities.

OTHER DUTIES:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.