Make proactive outreach to health plan members, pharmacies, and healthcare providers to identify and close medication related clinical care gaps in support of Medicare Star measures.
Review medication histories, pharmacy claims and available clinical information to identify opportunities for appropriate medication usage.
Educate and support members regarding pharmacy benefits, medications, and the importance of following evidence-based treatment recommendations to support positive health outcomes.
Communicate with healthcare providers and pharmacy staff to obtain information, coordinate care, and facilitate resolution of medication and other related care gaps.
Research and resolve pharmacy claims issues, including troubleshooting adjudication problems and coordinating corrections with internal teams or external partners.
Record outreach activity and document member interactions to support care gap monitoring and improvement.
Collaborate with internal teams and leadership to ensure timely resolution of issues impacting quality measures.
Perform other duties as assigned to support team, organization, or program needs.

Benefits & Schedule Full-Time, in-office, Monday-Friday, 9:00am-5:30pm Medical, dental, vision, and life insurance 401(k) match eligible Paid time off

Performance Bonus Eligible Pay:

Up to $24.72 per hour

Benefits:

401(k) 401(k) matching AD&D insurance Dental insurance Health insurance Health savings account Life insurance Opportunities for advancement Paid sick time Paid time off Retirement plan Vision insurance Application Question(s): Are you willing to consent to random drug screens and complete a background check?

Experience:

retail pharmacy: 1 year (Preferred) PBM or health plan work: 1 year (Preferred) Medicare Stars, HEDIS, or other clinical quality initiative: 1 year (Preferred) patient outreach and documentation: 1 year (Preferred)

License/Certification:

Arizona Pharmacy Technician License (Preferred) Ability to

Commute:

Glendale, AZ 85308 (Required)

Work Location:

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