Pharmacy Quality Specialist

Description

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the healthcare equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs, and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

Summary Description

Under the direction of the Vice President of Pharmacy, The Pharmacy Quality Specialist will be a critical role that will be primarily focused on improving medication adherence rates while also supporting the overall success of all Part D STAR measures.

The primary function of the Pharmacy Quality Specialist is to perform telephonic outreach to Zing members, pharmacies, and providers for the purpose of addressing prescription medication adherence. You will be responsible for assisting to obtain needed prescribed medications, determining barriers to medication adherence, and working to overcome those barriers.

Essential Functions

• Provide service resolutions as first-line contact for medication adherence issues.
• Aim to provide first-call resolution.
• Telephonic outreach to members, pharmacies, and providers.
• Will work in a call queue where productivity and quality are monitored.
• Meet service level goals (call quality, daily/weekly call performance expectations).
• Maintain member privacy by strictly adhering to HIPAA regulations.
• Answer complex telephonic questions from customers while ensuring an elevated level of customer service and maximizing productivity with minimum downtime.
• Manages member correspondence, as necessary.
• Will keep track of issues and timelines, research and resolve complex issues, and compile required documentation for daily activities.
• Refers requests for escalation as needed and engages other internal areas such as Pharmacy, Care Management, Appeals & Grievances, Program Management, IT, and other Contact Center teams to resolve issues.
• Performs other assignments as needed and required.
  
  

Requirements

QUALIFICATIONS AND REQUIREMENTS:

Job Requirements

Knowledge, Skills, and Abilities:

• Must always maintain a professional, member-centric demeanor.
• Effectively navigate and comprehend all elements of Zing Health systems, and partnering systems, which are applicable to the business.
• Partner with network pharmacies, physicians, care management, or other support organizations/ staff within or outside of Zing to optimize medication regimens and communicate supportive pharmacy services.
• Demonstrate continuous improvement in medications adherence rates or other quality improvement measures as assigned.
• Can capture data, observations, and bring solutions forward to Zing leadership.
• Understand and explain Medicare Part D pharmacy terms such; formulary, step-therapy, prior authorization and quantity limits to members or other healthcare professionals.
• Articulate and understand how to communicate with seniors using the telephone by presenting a warm, friendly, and empathetic atmosphere to members.
• Utilize active listening techniques and ensure privacy and confidentiality as required by HIPAA, company, and departmental guidelines.
• Active listening skills and the ability to write effectively to create documents as needed.
• Member Focus; elevated level of empathy and emotional intelligence; Focuses on opportunity to service members with a high level of empathy.
• Ability to adapt to a variety of situations easily and effectively navigate situations.
• Ability to think critically and solve the following issues from start to resolution.
  
  

Required Qualifications

• High School or GED required.
• Fluent in English/Spanish (a plus).
• 1+ years in a health plan, PBM, provider, call center, medical billing, or care management organization highly preferred.
  
  

Preferred Qualifications

• Licensed Pharmacy Technician (CPhT) or Licensed Practical Nurse (LPN) preferred
• Call Center operating metrics and performance management experience.
• Knowledge of pharmacy benefits, health care insurance, and/or medical billing