Job Description
Job Description
POSITION SUMMARY
This position is responsible for supporting the Part D Operations and Pharmacy Measures for the CMS STARS program. The candidate serves as the primary liaison that will help to drive Part D Star Measures performance through outreach efforts to prescribers, pharmacies and members. The candidate will engage in call campaigns to close out medication adherence gaps and drive operational excellence through patient education. The candidate will also serve as primary support to the Part D Operations Coordinator in managing PBM oversight activities and conducting day-to-day pharmacy operational activities.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, the candidate must be able execute essential functions satisfactorily, with or without a reasonable accommodation, including, but not limited to the following:
- Act as a liaison between STARS leadership team and external provider entities
- Assist the Pharmacy Operations VP, the Part D coordinator and the department analyst with the operational day-to-day processes tied to CMS compliance, PBM oversight, and Part B & D medication access
- Engage to ensure that PBM oversight functions align with regulatory guidance and desired departmental expectations
- Collaborate with Part C and Part D Star measure owners and the Stars leadership team to report progress to management
- Successfully identify and close performance gaps within the health plan Stars program to drive better outcomes
- Review reports and organize data to perform telephonic outreach
- Establish project management plans containing methods and practices consistent with corporate objectives for driving Part D Medicare Star Program performance
- Conducts outbound calls to prescribers, pharmacies, and members to educate and close out gaps on STARS measures
- Monitor outreach efforts outcomes to improve the quality and efficiency of Stars related Part C and Part D projects
- Advise and educate staff on appropriate actions to take to satisfy the STARS measure specifications
- Participate in departmental meetings with the Quality and Pharmacy leads to present data as it relates to STARS
- Perform additional tasks as assigned
QUALIFICATIONS & EDUCATION
- Active Florida Board of Pharmacy Registered Technician Licensure
- Two (2) years prior experience working in a health care environment or equivalent pharmacy retail experience
- Preferred two (2) years managed care experience with primary focus on the Medicare line of business
- Knowledge of health care performance measurement CMS Part D Stars ratings strongly preferred
- Excellent verbal and written communication skills
- Commitment to excellence and high standards
- Strong organizational, problem-solving, and analytical skills
- Able to manage priorities and workflow
- Ability to demonstrate a high level of professionalism in dealing with confidential and sensitive issues
- Ability to work effectively, independently and in a team environment
- Ability to deal effectively with a variety of individuals
- Fluency in Spanish and English required
- Proficiency in computer software (i.e. Microsoft Word, Excel, Power-Point, and Outlook), and the ability to learn new and complex computer system applications (including comfort using short-cut keys/demands)
WORKING CONDITIONS
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
- The noise level in the work environment is usually moderate
- Interacts with health plan members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances
- This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity
- The work is performed onsite at the office
- All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays as needed
- Work schedule is approximate, and hours/days may change based on company needs
This Job Description may be modified at any time at the discretion of the employer as business operation may deem necessary. This does not constitute an employment agreement and may not include all duties.
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.