Medication Adherence and Quality Performance Specialist

The Medication Adherence & Quality Performance Specialist plays a vital role in ensuring the highest quality care for assigned patients while adhering to regulatory reporting requirements related to quality measure compliance. This position supports staff training, coordination, and outreach efforts, 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 work closely with 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 commitment to patient care, innovation, and a thorough understanding of programs that align with organizational 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, addressing objections to compliance by providing education, facilitating resources, navigating benefits, and coordinating necessary care.
- Assist provider practices in identifying workflow gaps and recommend 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 meticulous attention to detail, ensuring complete, accurate, and timely documentation of customer interactions, demographic updates, and other relevant information.
- Develop and maintain professional relationships with health plan representatives, provider practices, and internal departments to support organizational goals.
- Perform accurate and efficient medical record reviews 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 while maintaining strict confidentiality and adhering to HIPAA guidelines and policies.
- Proactively escalate any gaps or issues to supervisors or designated business owners.
- Establish organizational structures for savings, compiling, and reporting data effectively.
- Navigate vendor portals, electronic medical records, and internal systems to extract and process data efficiently.
- Prepare executive reports and presentations to communicate Key Performance Indicators (KPIs).
- Utilize organizational applications to facilitate effective communication with employees and customers.
- Perform other duties as assigned.

Required Qualifications

- Doctor of Pharmacy (Pharm.D) degree from a reputable university.
- Ability to multitask and work effectively under tight deadlines.
- Basic understanding of the healthcare industry.
- Professional conduct with strong communication skills and basic proficiency in English.
- Minimum of 1 year experience using Microsoft Word and Excel, particularly for reporting purposes.
- Proficiency in navigating various Electronic Medical Record (EMR) systems and software interfaces.
- Demonstrated ability to work independently toward goals with strong attention to detail and problem-solving skills.
- Target-oriented mindset and positive attitude.
- Willingness 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 an opportunity to contribute meaningfully to patient care quality and organizational success within a dynamic healthcare environment.