Job Description

Summary

As part of the Member Outreach team in QM, the Medication Management Coordinator outreaches directly to members and handles inbound calls related to monitor medication adherence. This may include assisting the member to obtain prescribed medications.

Duties and Responsibilities:

Utilize health plan and internal reporting to identify members in medication adherence denominators and use this as a basis for outreach to ensure that members have needed access to prescribed medications

Document attempts to reach members and outcome of calls in Cozeva and/or sPHERICAL Solutions

Provide members with information regarding health plan incentive programs as applicable

Provide members with various routes for obtaining medications including contracted pharmacies and home delivery programs

Promote utilization of 100-day medication supplies so medication refills can be reduced to 3x a year from 4x

Attend and engage in health plan JOMs and QM meetings when medication adherence will be part of the discussion

Work directly with health plan pharmacists when requested to discuss special pharmacy programs and/or member engagement in the program

Develop innovative methods to encourage member medication adherence

Encourage providers to perform medication reconciliation following member hospitalization

Provide updates to HEDIS/STARs Specialists

Obtains records from EHR systems if access available

Safeguard the patient records and ensure that the procurement process is in compliance with HIPPA standards

Assist HEDIS/STARs Specialists on special projects as needed

Additional projects in the Quality Management department as required

Minimum Job Requirements:

• High School graduate or GED equivalent
• 2+ years working in outpatient pharmacy or managed care
• Pharmacy Technician highly preferred (Passage of National Pharmacy Technician Certification Exam- PTCE)
• Considerable knowledge of medication names (both trade and generic) and their doses

Skills and Abilities:

• Demonstrates member interview skills along with strong written and verbal communication skills
• Highly motivated individual who is self-directed and able to prioritize essential tasks and meet deadlines
• Basic understanding of HEDIS, STAR ratings
• Effective interpersonal skills
• Ability to multitask in a busy department
• Minimum or higher proficiency level with Microsoft Office Programs; primarily Word and Excel 2013 or higher
• EZ-CAP® and Cozeva knowledge a plus

Salary Range:

• $24-26 / hourly

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