Job Description

We're seeking a Pharmacy Quality Specialist to join our team! The Pharmacy Quality Specialist will provide assistance to Pharmacists and/or Advanced Practice Clinicians to support Medication Therapy Management (MTM) and quality programs. The Pharmacy Quality Specialist will complete outreach calls to eligible health plan members and/or caregivers to introduce and explain the MTM benefit, verify and obtain demographic and medication-related information, schedule appointments for the MTM Pharmacist to complete the comprehensive medication review or target intervention. This position will also support Medicare Star and other quality initiatives.

**Note: The designated shift will be 10 AM - 7 PM EST (Monday - Friday)***

What You'll Do

• Verify member demographic information, provider and pharmacy contact information and enter into the MTM platform as needed

• Contact members to introduce and explain the benefits of the MTM program and follow up as needed and to schedule appointments for the MTM Pharmacist to complete the Comprehensive Medication Review or the Targeted Intervention

• Receive and respond to calls from provider offices, members and pharmacies; make determinations of appropriate action required from calls and escalate calls as needed

• Coordinate outbound faxing and subsequent follow-up calls with health care providers

• Assess and interprets member needs and requirements, triaging to a clinical pharmacist or other areas when appropriate

• Support Medicare Star and other quality initiatives

What You Bring

• High school diploma or GED

• 3+ years of experience in related field.

• Active pharmacy technician license in the state of North Carolina (PTCB: Pharmacy Technician Certification Board - Nationally Accredited Certification Exam), preferred.

Bonus Points (preferred qualifications)

• Strong customer service skills with demonstrated ability to engage with patients and health plan members in a professional and empathetic manner.

• Excellent communication skills tailored to customer, patient, and member needs.

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community

• Work-life balance, flexibility, and the autonomy to do great work

• Medical, dental, and vision coverage along with numerous health and wellness programs

• Parental leave and support plus adoption and surrogacy assistance

• Career development programs and tuition reimbursement for continued education

• 401k match including an annual company contribution

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$45,761.00 - $73,217.00

Skills

Documentations, Health Care, Health Care Quality Improvement, Health Insurance Verification, Health Plans, Medical Triage, Medication Reviews, Patient Care, Patient Support, Pharmacy, Pharmacy Operations, Policy Development, Procedure Development, Quality Assurance (QA), Quality Improvement, Regulatory Compliance

_____________________________________________________________________

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.