Pharmacy Quality Coordinator

Job Description

The Pharmacy Quality Coordinator provides support on CMS/HEDIS initiatives and processes to close care gaps for drug-related measures through member and prescriber outreach efforts.

Responsibilities

• Make outreach calls to members to address care gap issues. For example, identify root causes for medication adherence issues and provide education to help resolve the problems. Help members be set up for mail order prescriptions and handle follow-up mailings. Confirm members' current medications and identify discrepancies.
• Provide administrative support for Performance Programs and other pertinent departments for collaboration on STARIHEDIS/P4P initiatives. Maintain the internal tracker with dates and activities summarized and provide regular reporting on patients who are /are not at target goals based on CMS STAR metrics.
• Communicate with physician offices to clarify prescription orders, follow up on pharmacist recommendations on medications or fax communications, and call in appropriate prescriptions to dispensing pharmacies.
  
  

Qualifications

High School Diploma required. Active pharmacy technician license required (PTCB/national pharmacy technician license preferred).

Prior work experience in pharmacy setting (i.e. retail pharmacy) or managed care setting is preferred. Bilingual in Spanish preferred. Working knowledge of MS Word and Excel. Excellent verbal and written communication skills. Good negotiation skills. Strong organization skills and ability to prioritize daily tasks. Ability to maintain member confidentiality and protect operations by keeping confidential information in compliance with HIPAA requirements.

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.