STARS Specialist- Pharmacy

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Southfield, MI

Emergent Holdings

<p class="p1"><strong>Emergent Holdings is driven by a singular goal &mdash; improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions, and services to support our key stakeholders &mdash; individuals, employers, providers, and strategic partners &mdash; improving the health and safety of the people and places we serve.</strong></p>

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Competitive Compensation and Benefits Package

Overview: <p>This position is responsible for supporting clinical and operational processes for clinical pharmacy STAR measures within Medicare. This includes executing member, provider and pharmacy interventions to resolve any barriers preventing a member from becoming adherent to their medication regimen. This position will also be responsible for triaging calls to appropriate staff based on the complexity of the call. The Pharmacy Stars Specialist will interact with pharmacists, interns, pharmacy students and analysts to support current programs and assist in quality reviews to ensure continued process improvement</p>
Responsibilities: <ul> <li>Monitor toll-free call center, handle in-coming member, provider, and pharmacy calls</li> <li><a target="_blank">Independently address and resolve adherence barriers at the member, provider, or pharmacy; including documenting activity and outcome</a></li> <li>Subject matter expert in all benefit designs and formularies to resolve issues in real-time</li> <li>Create branch-tree logic for resolving claims issues and member complaints</li> <li>Document processes, create FAQ sheets and training materials for new hires</li> <li>Effectively communicate to upper management calls that require escalation</li> <li>Assist leadership by investigating challenges and issues to determine root cause and recommend innovative solutions to bring resolution &nbsp;</li> <li>Assist in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.</li> <li>Assist in monitoring program initiatives, outcomes, and objectives to ensure goal attainment within defined parameters</li> <li>Assist in the development of plans, reports, papers, and creation of other documents to ensure process improvements and work efficiencies</li> <li>Other duties as required.</li> </ul>
Requirements: <p><strong>EDUCATION OR EQUIVALENT EXPERIENCE:</strong></p> <ul> <li>Associate&rsquo;s degree required. Bachelor&rsquo;s preferred</li> <li>Active unrestricted Pharmacy Technician License or</li> <li>Pharmacy Technician Certification (PTCB) required.</li> </ul> <p><strong>EXPERIENCE:</strong></p> <ul> <li>At least two (2) years&rsquo; experience in retail or hospital pharmacy preferred</li> <li>Knowledge of prescription drug names and therapeutic classes</li> <li>Experience with Medicare Part D prescription benefits is preferred</li> </ul> <p><em>&nbsp;</em></p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:&nbsp;</strong><em>(Brief bullet points detailing the skills necessary for this position)</em></p> <ul> <li>Strong customer service and phone skills.</li> <li>Strong verbal and written communication skills to handle complex situations</li> <li>Project management skills</li> <li>High level of proficiency with Microsoft Office products</li> <li>Strong ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels.</li> <li>Knowledge of pharmacy claims processing; working knowledge of Medicare Part D is preferred</li> <li>Understanding of formularies and utilization management edits</li> <li>Ability to effectively present process improvements, root cause analysis or solutions in one-on-one or small staff meetings</li> <li>Ability to multi-task and shift priorities with ease to meet business needs</li> </ul>