Job DescriptionThe Pharmacy Quality Specialist will provide assistance to Pharmacists and/or Advanced Practice Clinicians to support Medication Therapy Management (MTM) and quality programs. The Pharmacy Quality Specialist will complete outreach calls to eligible health plan members and/or caregivers to introduce and explain the MTM benefit, verify and obtain demographic and medication-related information, including documentation of medication lists, schedule appointments for the MTM Pharmacist to complete the comprehensive medication review or target intervention. This position will also support Medicare Star and other quality initiatives.What You'll Do
Verify member demographic information, provider and pharmacy contact information and enter into the MTM platform as needed
Contact members to introduce and explain the benefits of the MTM program and follow up as needed and to schedule appointments for the MTM Pharmacist to complete the Comprehensive Medication Review or the Targeted Intervention
Receive and respond to calls from provider offices, members and pharmacies; make determinations of appropriate action required from calls and escalate calls as needed
Coordinate outbound faxing and subsequent follow-up calls with health care providers
Assess and interprets member needs and requirements, triaging to a clinical pharmacist or other areas when appropriate
Support Medicare Star and other quality initiatives
What You'll Bring (Hiring Requirements)
High school diploma or GED
3+ years of experience in related field.
Preferred candidates will hold a current Pharmacy Technician Certification in the state of North Carolina or obtain certification within the first 90 days of employment.
Salary RangeAt Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.Based on annual corporate goal achievement and individual performance.$47,300.00 - $66,600.00About UsIt's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.Authorization to Work in the United StatesWe use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.Request AccommodationsBlue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at HR.Staffing@bcbsnc.com .For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
