Medication and Quality Performance Specialist

Summary

The Medication Adherence & Quality Performance Specialist will uphold the highest quality care for all assigned patients, understanding the regulatory reporting requirements for quality measure compliance. This role will assist the organization in staff training, coordination, and outreach events, as well as documented compliance with quality measures in accordance with HEDIS and/or payer quality requirements.

The Medication Adherence & Quality Performance Specialist will report to the Director of HEDIS & Payer Quality Performance. The Population Health Team is committed to supporting IntraCare’s network of primary care physicians to achieve improvements in patient care outcomes and financial rewards related to value-based care. Population Health Team members must have a passion for patient care and creative innovation and insight into programs that support the company’s goals and initiatives.

Key Responsibilities:

• Outreaches to medical practices, providers, and patients with recommendations for health screenings, patient assessments, management of chronic conditions, and well-care visits.
• Successfully engages patients directly via telephone and overcomes objections to compliance by providing education, facilitating resources, navigating benefits, and arranging needed care.
• Supports provider practices in identifying workflow gaps and suggesting best practices to improve performance in clinical and quality metrics. Performs virtual visits with practices as needed.
• Tracks all tasks closely to completion and reports progress in order to ensure positive performance results.
• Collects and enters data with high attention to detail. Documents information completely, accurately, and in a timely manner. Keeps records of customer interactions, demographic updates, and other key details.
• Builds and maintains professional relationships with individuals and organizations that can support IntraCare’s goals including but not limited to health plan representatives, provider practices, and internal departments.
• Accurately and efficiently conducts medical record review and abstraction. Scans relevant components for the medical record to support reviews performed.
• Works collaboratively with Network and MSO departments to improve quality results.
• Optimizes customer satisfaction with both providers and patients.
• Maintains confidentiality and adheres to HIPAA requirements including communication procedures, guidelines, and policies.
• Proactively escalates gaps and issues of attention to supervisor or designated business owner
• Establish an organizational structure for savings, compiling, and reporting out on data
• Navigate vendor portals, electronic medical records, and internal systems to extract and process data
• Create executive reports and presentations to communicate Key Performance Indicators (KPIs)
• Utilize organizational applications to effectively communicate with employees and customers
• Other duties as assigned.

Required Qualifications:

• Pharm.D ( Doctor of Pharmacy ) from a reputable University
• Ability to multi-task and work under narrow timelines
• Basic understanding of the healthcare industry
• Professional conduct and communication skills set with basic English language
• 1+ years of working experience with Microsoft Word and Excel (particularly for reporting)
• Software literate to grasp different interfaces of different EMRs
• Demonstrated ability to work independently toward established goals, attention to detail and problem-solving skills
• Target orientated personality and attitude
• Keen to learn and expand knowledge within the industry

Preferred Qualifications:

EMR (Electronic Medical Records) knowledge and experience

• Relevant experience in the healthcare industry

Familiarity with medical terminology

• 1+ years of HIPAA compliance requirements knowledge

Experience in Medicare programs, such as Medicare Advantage, Medicare Shared Savings, and Accountable Care Organizations

Job Type: Full-time

Work Location: In person