Pharmacy Quality Coordinator

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Reporting to the Senior Director of Pharmacy Services, the Pharmacy Quality Coordinator is primarily responsible for supporting day-to-day administrative and operational activities for WellSense’ s clinical and quality management programs.  The clinical and quality management programs are targeted towards improving performance for key quality measures in support of contractual, regulatory, and accreditation requirements within the Medicaid and Commercial lines of business.  In this role, the Pharmacy Quality Coordinator will interact with a multi-disciplinary team that includes, but is not limited to, Pharmacists, Medical Directors, Providers, Care Managers, Population Health Liaisons, and Members. The Pharmacy Quality Coordinator communicates directly with Members and Providers to provide medication adherence support, medication management resources, and supports coordination of care, where appropriate. They are responsible for obtaining medication histories, coordinating resolution of and in some cases resolving comprehensive pharmacy benefits investigations, providing member education resources, and other medication management related tasks such as producing provider communications with identified clinical gaps and/or concerns. In this role, the individual must be able to plan, organize, and prioritize work to ensure accurate and timely completion. The Pharmacy Quality Coordinator must have a well-versed understanding of the clinical programs we support and exhibit clear, active communication with the team, Members and Providers to be successful in this role.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

 Key Functions/Responsibilities:

 ·         Responsible for documenting and data entry of program activities, member information, notifications, or other administrative materials within the appropriate clinical management systems or reports; may require completion of questionnaires or surveys

·         Coordinate prior authorization needs with the PBM and/or the Pharmacy Services team to improve gaps in medication management as needed

·         Conduct direct Member and Provider outreach to intake medication histories, treatment plans, and any other clinically relevant information; apply motivational interviewing skills to enhance engagement

·         Identifies potential medication-related issues and is able to resolve, facilitate, or escalate to Managers or clinicians

·         Facilitate communications with Providers on medication care plans to close gaps in care

·         Triages cases to clinical staff, or other team members as appropriate

·         Navigate systems, reporting, and resources to effectively answer questions and resolve issues.

·         Acts as a primary point of contact for clinical program inquiries

·         Develops and maintains knowledge on quality-related contractual, accreditation, and industry-standard quality measures.

·         Has the ability to proactively identify areas for improvement of existing workflows and develop recommendations to department management; follows through with implementation where assigned

·         Serves as a representative of the pharmacy department and collaborates cross-functionally on prioritized initiatives, which may relate to quality, customer service, medical management, or compliance

·         Supports ad-hoc projects and audit activities as needed

·         Other duties as assigned

 Supervision Received:

 ·         General supervision received weekly

Qualifications:

Education Required:

·         Minimum of a High School diploma or equivalent required. Associate or Bachelor’s degree preferred

Experience Required:

·         Three or more years of experience in a clinical professional setting required

·         Three or more years prior pharmacy experience required

·         Three or more years of patient care/interaction experience

·         Prior customer service experience required

Experience Preferred/Desirable:

 ·         Two or more years of managed care experience

·         Prior experience performing tasks related to medication therapy management or equivalent patient management programs

 Required Licensure, Certification or Conditions of Employment:

 ·         Certified pharmacy technician

·         Successful completion of pre-employment background check

 Competencies, Skills, and Attributes:

 ·         Excellent Customer Service skills

·         Prior experience assisting members and/or providers with inquiries

·         Ability to effectively collaborate with health care providers and all members of the interdisciplinary team

·         Strong organizational, problem solving, communication, and interpersonal skills

·         Excellent written and oral communication skills required.

·         Must have strong data entry and attention to detail in documentation and data entry

·         Must be able to multitask and be results oriented

·         Demonstrated time management skills and be able to function independently

·         Effectively work in a matrix environment to accomplish work across multiple teams in the health plan and health system

·         Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry-processing applications.

·         Experience with analytical and problem solving skills.

 Working Conditions and Physical Effort:

 ·         Regular and reliable attendance is an essential function of the position.

·         Ability to work in a fast-paced environment.

·         Work is normally performed in a typical interior/office work environment.

·         No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.