Collaborate with pharmacists to proactively engage health plan members to improve their medication adherence and positively impact health outcomes. Develop and deliver communication to members that is cognizant of cultural, ethnic, and other differences in order to effectively maximize probability of success in modifying behaviors. Play a critical role in facilitating outreach efforts and ensuring timely follow-up to address barriers to adherence. Partner closely with the Quality Pharmacy Team to drive quality performance and enhance member satisfaction. Responsibilities
Engage with members to understand reasons for non-adherence.
Craft and deliver empathetic, culturally sensitive, and solution-oriented support to members during outreach.
Provide a positive member experience by reinforcing the importance of medication adherence and connecting members to appropriate resources.
Identify barriers to adherence and support resolution of common issues such as refill delays, cost concerns, or lack of understanding of medication purpose.
Develop and document outreach efforts while maintaining detailed and accurate records of member interactions to ensure timely and effective communication.
Escalate clinical concerns to pharmacists as needed.
Adhere to all regulatory, privacy, and compliance standards in member communications and data handling.
Ensure all outreach activities are conducted in accordance with organizational policies and clinical protocols.
Work closely with the Quality Pharmacy Team to align outreach strategies with organizational goals and quality initiatives.
Participate in regular team huddles or strategy sessions to share insights and improve outreach effectiveness.
Manage multiple outreach tasks and follow-ups efficiently, ensuring timely and accurate documentation.
Prioritize work based on member needs, outreach schedules, and team objectives.
Qualifications
Associates degree; bachelor’s degree preferred.
National Pharmacy Technician Certification required, or must be obtained within 6 months of hire date as a condition of continued employment; and certification must be maintained while employed in this role (Required)
3 – 5+ years of relevant, professional work experience (Required)
2+ years of pharmacy related experience (Required)
2+ years of call center customer service experience (Required)
Additional experience / specialized training may be considered in lieu of degree requirement (Required)
Claim system knowledge with ability to analyze pharmacy claims (Required)
Knowledge of Medicare Part D (Required)
Excellent communication skills with employees, practitioners and members regarding verification and explanation of pharmacy benefits (Required)
Excellent organizational, prioritization and time management skills (Required)
Detail oriented with strong analytical, problem solving and follow up skills (Required)
Work independently within a team environment with/little direct supervision (Required)
Demonstrated proficiency using personal computers, MS Office software including Word, Excel, and Access (Required)
Ability to work in a high pace, stress environment (Required)
Additional Information
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