Medication Adherence and Quality Performance Specialist

The Medication Adherence & Quality Performance Specialist plays a vital role in ensuring the highest quality of care for assigned patients while adhering to regulatory reporting requirements related to quality measure compliance. This position supports the organization through staff training, coordination, and outreach initiatives, ensuring documented compliance with quality measures in line with HEDIS and payer quality standards. Reporting to the Director of HEDIS & Payer Quality Performance, the specialist will be part of the Population Health Team, which is dedicated to assisting IntraCare’s network of primary care physicians in improving patient outcomes and achieving financial incentives tied to value-based care. This role requires a strong passion for patient care, innovation, and insight into programs that align with the company’s strategic goals.

Key Responsibilities

- Conduct outreach to medical practices, providers, and patients, offering recommendations for health screenings, patient assessments, chronic condition management, and well-care visits.
- Engage patients directly via telephone, overcoming objections to compliance by providing education, facilitating resources, navigating benefits, and arranging necessary care.
- Support provider practices by identifying workflow gaps and recommending best practices to enhance clinical and quality metric performance; conduct virtual visits with practices as needed.
- Monitor and track all assigned tasks to completion, reporting progress to ensure positive performance outcomes.
- Collect and enter data with precision, documenting information completely, accurately, and promptly while maintaining records of customer interactions, demographic updates, and other relevant details.
- Build and maintain professional relationships with health plan representatives, provider practices, and internal departments to support organizational goals.
- Perform accurate and efficient medical record review and abstraction, scanning relevant components to support quality reviews.
- Collaborate with Network and MSO departments to drive improvements in quality results.
- Enhance customer satisfaction for both providers and patients.
- Maintain confidentiality and comply with HIPAA regulations, including communication procedures, guidelines, and policies.
- Proactively escalate gaps or issues to supervisors or designated business owners.
- Establish organizational structures for savings, compile data, and report findings.
- Navigate vendor portals, electronic medical records, and internal systems to extract and process data efficiently.
- Create executive reports and presentations to communicate Key Performance Indicators (KPIs).
- Utilize organizational applications to communicate effectively with employees and customers.
- Perform other duties as assigned.

Required Qualifications

- Pharm.D. (Doctor of Pharmacy) degree from a reputable university.
- Ability to multitask and work effectively under tight deadlines.
- Basic understanding of the healthcare industry.
- Professional conduct and communication skills with proficiency in basic English.
- Minimum of 1 year experience using Microsoft Word and Excel, particularly for reporting purposes.
- Proficiency in navigating various Electronic Medical Record (EMR) systems.
- Demonstrated ability to work independently toward established goals with strong attention to detail and problem-solving skills.
- Target-oriented mindset and attitude.
- Eagerness to learn and expand knowledge within the healthcare industry.

Preferred Qualifications

- Experience and knowledge of Electronic Medical Records (EMR) systems.
- Relevant healthcare industry experience.
- Familiarity with medical terminology.
- At least 1 year of knowledge regarding HIPAA compliance requirements.
- Experience with Medicare programs such as Medicare Advantage, Medicare Shared Savings, and Accountable Care Organizations.

This role offers the opportunity to contribute meaningfully to patient care quality and organizational success within a dynamic and supportive team environment.