Medicare Quality Specialist Pharmacy

This is a fully remote position with set working hours of 8:00 AM to 5:00 PM Eastern Standard Time.

Job Summary

The Medicare Quality - Pharmacy Specialist is responsible for conducting high-volume outbound member outreach calls to support Medicare Stars programs.

This position is primarily phone-based, with the majority of the workday dedicated to making and receiving calls with Medicare members, pharmacies, and healthcare providers. The Specialist plays a key role in improving medication adherence, closing care gaps, and supporting CMS quality initiatives through member education and care coordination with clinical pharmacists. Success in this role requires strong communication skills, attention to detail, and the ability to meet daily productivity and quality performance standards in a structured call center environment.

Essential Functions

• Conduct high-volume outbound member outreach calls to address medication adherence gaps and improve Medicare Star measure performance (e.g., diabetes, hypertension, statin).
• Educate members on the importance of medication adherence and assist in overcoming barriers (e.g., transportation concerns, setting up refill reminders).
• Assist members in understanding their pharmacy benefits and refer to appropriate internal teams when needed (e.g., Care Management, Mail Order Pharmacy).
• Identify and assist in resolving pharmacy billing issues or access barriers impacting adherence outcomes.
• Process medication refill requests and coordinate communication between members, pharmacies, and providers.
• Identify and transfer members to a license clinical pharmacist to resolve medication-related issues and improve member outcomes.
• Assist in the administration of the Medication Therapy Management (MTM) program which includes scheduling CMRs, processing opt-outs, and other activities assigned to support program.
• Document all outreach activities accurately and in accordance to departmental standards.
• Meet or exceed daily productivity, call volume, quality, and documentation accuracy targets.
• Ensure compliance with CMS requirements, HIPAA regulations, and organizational requirements.
• Participate in team meetings and quality improvement initiatives aimed at enhancing Medicare Star Ratings and member experience.
• Support special projects and organizational initiatives as assigned.

Qualifications

Required

• 2+ years of pharmacy technician experience (retail, managed care, PBM, mail order, specialty, or call center)
• Strong verbal communication skills with the ability to effectively engage Medicare beneficiaries.
• Ability to work in a high-volume, production-driven call environment with extended time on the phone.
• Demonstrated ability to meet productivity and quality performance expectations.
• Strong organizational skills and attention to detail.
• Basic proficiency in Microsoft Office applications.

Preferred

• Bachelors degree or equivalent
• Active Michigan pharmacy technician license and NABP Certified Pharmacy Technician (CPhT) certificate
• Experience supporting Medicare Stars medication adherence measures
• Experience in Medicare Advantage programs
• Call center or outbound outreach experience
• Knowledge of CMS Stars, CAHPS, and adherence-related quality metrics

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids

Department Name

Clinical Pharmacy Government Products - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.