Pharmacy Government Stars Specialist

Job Description:

Remote work eligibility: We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Rhode Island, Vermont, and Washington.

Interview requirement for remote jobs: Please note that an on-camera recorded video interview through Microsoft Teams will be required, as well as onsite interviews and/or meetings,

Job Specifics

Schedule: Monday – Friday, 8:00 a.m. – 5:00 p.m. Mountain Time.

Benefits Eligible: Yes - Link to Benefit Details

Location: This is a fully remote position. Candidates must reside in an Intermountain Health state: Utah, Colorado, Idaho, Wyoming, Montana, or Nevada. Candidates outside of these states will not be considered.

Top candidates: Candidates with pharmacy experience and CMS Stars experience are strongly preferred.

Join Intermountain Health's Pharmacy Government Stars Programs team and play a key role in helping members improve their health outcomes while supporting the success of Medicare quality initiatives. As a Pharmacy Government Stars Specialist, you will serve as a trusted resource for members, providers, and pharmacies, helping identify and remove barriers to medication adherence, access to care, and overall health improvement. If you enjoy helping others, collaborating across teams, and making a meaningful impact on the member experience, this is the job for you.

The Pharmacy Government Stars Specialist is responsible for supporting and improving the quality performance of Government programs, particularly Medicare, with a focus on medication adherence, member engagement, and quality outcomes. This role supports CMS Stars initiatives, including Medication Therapy Management (MTM), Medication Adherence, Statin Use in Persons with Diabetes (SUPD), and other quality improvement programs designed to enhance CMS Star Ratings.

This is a highly engaged, member-focused role that combines pharmacy knowledge, patient outreach, and quality improvement. The specialist serves as a liaison between members, providers, pharmacies, and internal teams to identify barriers that impact health outcomes and quality measures. Through proactive outreach, education, problem-solving, and relationship building, the specialist helps members navigate challenges that may prevent them from receiving or taking medications as prescribed.

The majority of this role is conducted over the phone, with approximately 80% of the workday dedicated to outbound outreach to members, provider offices, and pharmacies. Successful candidates must be comfortable spending significant time on the phone, building rapport quickly, utilizing motivational interviewing techniques, and navigating complex conversations with empathy and professionalism.

Essential Functions

• Conduct outbound outreach to members, providers, and pharmacies to support medication adherence and quality improvement initiatives.
• Identify and address barriers impacting CMS Stars measures and member health outcomes.
• Collaborate with members, providers, pharmacies, and internal teams to improve medication access and resolve healthcare-related challenges.
• Educate members on the importance of medication adherence and participation in quality programs.
• Coordinate prescription refills and assist with issues that may delay medication access.
• Manage daily outreach activities, productivity goals, and work queues while maintaining quality standards.
• Accurately document interactions and maintain compliance with confidentiality, regulatory, and organizational requirements.
• Use available data and reporting to identify opportunities for intervention and improved performance.
• Participate in process improvement initiatives that enhance member experience and quality outcomes.
• Independently prioritize workload and manage multiple initiatives in a fast-paced environment.

Skills

• Pharmacy
• Pharmacy Benefits Management (PBM)
• Medical Prescriptions
• Pharmacy Claims
• Call Center
• Customer Service
• Problem Resolution
• Phone Calls (Inbound/Outbound)
• Oral Communication
• Written Communication
• Group Problem Solving
• Medicare Part D
• Medicaid
• Mentorship/Coaching
• Decision Making

Minimum Qualifications

• Demonstrated experience in a pharmacy or government benefits support role.
• Demonstrated ability to meet performance standards for a Pharmacy Government Specialist II
• Demonstrated ability to provide superior customer service
• Demonstrated ability to listen and communicate effectively
• Demonstrated ability to problem solve and work under pressure
• Demonstrated proficiency in navigating computer systems, typing, and technologies
• Demonstrated experience mentoring or training on pharmacy or government benefits

Preferred Qualifications

• Current National Pharmacy Technician certification.

Physical Requirements

• Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, patients/clients and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.

Location:

Work City:

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Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. 

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.