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Job DescriptionProvide support on CMS Star/HEDIS initiatives and processes to close care gaps for drug-related measures through member and prescriber outreach efforts
Responsibilities
Make outreach calls to members to address care gap issues.
Identify root causes for medication adherence issues and provide education to help resolve the problems.
Help members be set up for mail order prescriptions and handle follow-up mailings.
Confirm members’ current medications and identify discrepancies .
Provide administrative support for Performance Programs and other pertinent departments for collaboration on Star, HEDIS and P4P initiatives.
Maintain the internal tracker with dates and activities summarized and provide regular reporting on patients who are /are not at target goals based on CMS Star metrics.
Communicate with physician offices to clarify prescription orders, follow up on pharmacist recommendations on medications or fax communications.
Be proficient in Excel with ability to sort and filter cases based on priority.
Maintain reference documents related to the assigned role.
Follow up with appropriate personnel (both internally and externally) when problem arises.
Conduct ad-hoc projects, batch mailings/ faxing and follow-up to close gaps.
Create reports to track progress and intervention outcomes.
Participate in pharmacy orientation programs, pharmacy staff meetings, in-service educational programs and other functions as required by the pharmacy department. Complete required training, as assigned, within the established timeframes. Maintains regular attendance according to established policies.
Perform other job-related duties as assigned.
QualificationsRequired Education/Experience
High School Diploma or GED
Preferred Education/Experience
Bilingual in Spanish
Pharmacy Technician License
Prior work experience in a pharmacy setting (i.e. retail pharmacy) or managed care setting
About UsWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
Seniority level
Entry level
Employment type
Full-time
Job function
Quality Assurance
Industries
Mental Health Care, Medical Practices, and Hospitals and Health Care
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