Pharmacy Quality Specialist

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

The Pharmacy Quality Specialist supports pharmacy quality initiatives focused on improving medication-related quality outcomes, including Medicare Star Ratings, HEDIS, and other organizational quality measures. Working collaboratively with pharmacists, pharmacy leadership, providers, members, pharmacies, and internal teams, the Specialist identifies and addresses medication-related care gaps through member and provider outreach, data review, intervention tracking, and care coordination.

This role has a strong focus on medication adherence and pharmacy quality measures, supporting proactive identification of opportunities and timely interventions to improve member outcomes and organizational quality performance. The Pharmacy Quality Specialist supports initiatives across multiple measures, including medication adherence, statin use, medication safety, and other pharmacy-related quality programs.

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

• Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.
• Runs and reviews daily, weekly, and monthly reports to identify members with medication-related care gaps and opportunities associated with Medicare Stars, HEDIS, and other quality measures.
• Conducts telephonic outreach to members to identify barriers to medication adherence and support timely access to prescribed medications.
• Educates members regarding prescription refills, medication access, pharmacy options, benefit resources, and available assistance programs within the scope of the position.
• Conducts outreach to provider offices and pharmacies to support resolution of medication-related quality gaps and facilitate timely interventions.
• Supports pharmacy quality measures including Diabetes Medication Adherence, RAS Adherence, Statin Adherence, Statin Use in Persons with Diabetes (SUPD), Concurrent Use of Opioids and Benzodiazepines (COB), and Polypharmacy: Use of Multiple Anticholinergic Medications (Poly-ACH).
• Reviews pharmacy claims, medication histories, and other available data to identify adherence concerns, refill opportunities, potential medication discrepancies, and quality measure gaps.
• Identify members requiring pharmacist clinical review and appropriately escalates medication-related concerns or interventions requiring professional judgment.
• Tracks identified quality opportunities from initial identification through outreach, intervention, follow-up, and resolution.
• Performs ongoing follow-up with members, providers, and pharmacies to facilitate closure of identified care gaps.
• Documents member, provider, pharmacy outreach and intervention outcomes accurately and consistently within designated systems and tracking tools.
• Maintains logs, dashboards, reports, and other tracking mechanisms used to monitor quality measure performance, outreach effectiveness, and intervention outcomes.
• Supports targeted campaigns and quality improvement initiatives designed to improve medication adherence and pharmacy quality performance.
• Collaborates with pharmacists and pharmacy leadership to identify trends, barriers, and opportunities for improvement based on outreach and quality measure data.
• Serves as a liaison between members, providers, pharmacies, pharmacists, and internal departments to facilitate communication and resolution of medication-related quality opportunities.
• Assists members in navigating medication access barriers, including refill coordination, pharmacy-related issues, and benefit questions, escalating complex issues as appropriate.
• Supports provider-facing initiatives, including preparation of outreach materials, identification of actionable opportunities, and follow-up on pharmacist or provider recommendations.
• Participates in pharmacy quality meetings, team huddles, and other interdisciplinary meetings as appropriate.
• Assists with special projects and process improvement initiatives related to pharmacy quality, member experience, and medication-related outcomes.
• Maintain knowledge of applicable quality measures, workflows, policies, procedures, and regulatory requirements.
• Performs other duties as assigned to support pharmacy quality initiatives and organizational goals.

Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.

POSITION QUALIFICATIONS

Education:

• High School Diploma or equivalent

Licensure/certification:

• Required to have an active Maine Pharmacy Technician license prior to Martin's Point employment

Experience:

• 3 years customer service experience required
• Prior experience or exposure to pharmacy or managed care pharmacy preferred

Knowledge:

• Knowledge of Medicare Part D, Stars, and HEDIS quality measures preferred
• Familiarity with medication adherence strategies and population health workflows preferred

Skills:

• Proficiency with Microsoft Office/Excel
• Strong communication, organizational, and customer service skills.
• Strong interpersonal skills and ability to collaborate with internal and external clients
• Excellent customer services skills
• Superior written and verbal communication skills

Abilities:

• Ability to be flexible with changing priorities and work in a fast-paced environment
• Applies proactive and innovative solutions to improve process effectiveness when appropriate
• Self-motivated with ability to manage, prioritize and complete multiple projects in a timely fashion with limited supervision
• Takes appropriate initiative while soliciting input/advice
• Ability to handle confidential and sensitive information in a discreet and professional manner

Pay Range: $22.62 - $27.94 The pay range above reflects the anticipated base pay range based on a full-time position. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-related considerations. Employees may also be eligible for additional compensation, including incentive or commission-based programs, where applicable and subject to the terms of the relevant plan. In addition to base compensation, we offer a comprehensive benefits package including medical, dental, vision, retirement savings with employer contributions, paid time off (including volunteer time off!), pie day, and other employee benefits.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact View email address on aiapply.co

Do you have a question about careers at Martin’s Point Health Care? Contact us at: View email address on aiapply.co