Medication Management Coordinator

Summary

As part of the Member Outreach team in QM, the Medication Management Coordinator outreaches directly to members and handles inbound calls related to monitor medication adherence. This may include assisting the member to obtain prescribed medications.

Duties and Responsibilities:

1. Utilize health plan and internal reporting to identify members in medication adherence denominators and use this as a basis for outreach to ensure that members have needed access to prescribed medications
2. Document attempts to reach members and outcome of calls in Cozeva and/or sPHERICAL Solutions
3. Provide members with information regarding health plan incentive programs as applicable
4. Provide members with various routes for obtaining medications including contracted pharmacies and home delivery programs
5. Promote utilization of 100-day medication supplies so medication refills can be reduced to 3x a year from 4x
6. Attend and engage in health plan JOMs and QM meetings when medication adherence will be part of the discussion
7. Work directly with health plan pharmacists when requested to discuss special pharmacy programs and/or member engagement in the program
8. Develop innovative methods to encourage member medication adherence
9. Encourage providers to perform medication reconciliation following member hospitalization
10. Provide updates to HEDIS/STARs Specialists
11. Obtains records from EHR systems if access available
12. Safeguard the patient records and ensure that the procurement process is in compliance with HIPPA standards
13. Assist HEDIS/STARs Specialists on special projects as needed
14. Additional projects in the Quality Management department as required

Minimum Job Requirements:

• High School graduate or GED equivalent
• 2+ years working in outpatient pharmacy or managed care
• Pharmacy Technician highly preferred (Passage of National Pharmacy Technician Certification Exam- PTCE)
• Considerable knowledge of medication names (both trade and generic) and their doses

Skills and Abilities:

• Demonstrates member interview skills along with strong written and verbal communication skills
• Highly motivated individual who is self-directed and able to prioritize essential tasks and meet deadlines
• Basic understanding of HEDIS, STAR ratings
• Effective interpersonal skills
• Ability to multitask in a busy department
• Minimum or higher proficiency level with Microsoft Office Programs; primarily Word and Excel 2013 or higher
• EZ-CAP® and Cozeva knowledge a plus

Salary Range:

• $24-26 / hourly