Quality Improvement Part D Specialist (Hybrid)

Summary

The Quality Improvement Part D Specialist performs a key role in optimizing our HEDIS Part D services by devising and executing strategies focused on elevating quality standards and ensuring compliance with regulatory guidelines. A significant aspect of this role involves fostering strong communication channels with pharmacies, providers, and insurance companies to facilitate seamless data exchange, analysis, and reporting. Works closely with Providers and cross-functional teams to identify areas for improvement and ensure compliance with CMS regulations and standards.

Essential Duties and Responsibilities

• Engages physicians and office staff to facilitate discussions on medication adherence, prescription fills, and other metrics relevant to HEDIS Part D, aiming to gather comprehensive patient data.
• Communicates effectively with stakeholders to implement best practices and drive improvement initiatives.
• Gather, document, and verify medication-related data from pharmacies and physicians. Resolves discrepancies through effective communication and follow-up.
• Develop and implement quality improvement plans and initiatives aligned with HEDIS and CMS guidelines.
• Collaborate with cross-functional teams to address identified gaps and improve performance metrics.
• Maintains thorough and precise records of quality enhancement endeavors, results, and adherence actions.
• Prepare reports and presentations outlining progress, findings, and recommendations for management or regulatory bodies.
• Conduct training sessions for physicians /office staff to enhance understanding and compliance with HEDIS measures and standards.
• This position will involve dedicating several hours each day to making outbound calls.
• Performs other related duties as assigned.

Knowledge, Skills and Abilities

· Strong organizational skills with keen attention to detail

· Ability to handle time-sensitive information, manage priorities and workflow.

· Excellent verbal and written communication skills.

· Strong interpersonal skills and proven ability to interact with healthcare professionals.

· Demonstrated presentation skills and ability to conduct training sessions for healthcare professionals.

· Proficient with Microsoft Word, Excel, Outlook and Teams.

· Proven ability to handle multiple projects and meet deadlines.

Minimum Education and Experience

· Some college, plus two years of related professional work experience, or equivalent combination of education and experience.

· Strong understanding of HEDIS Part D guidelines and ability to drive initiatives that positively impact patient care and operational efficiency.

· Two years of call center and/medical office experience within healthcare industry.

· Excellent communication skills - Bilingual (English and Spanish) required.

· Proven ability to use MS Office and perform diverse clerical functions within a professional work environment.

Genuine Health Group offers a competitive compensation and benefits package that includes a 401k matching program, fully subsidized medical plans, paid holidays and much more. Base salary will be commensurate to professional experience.

Genuine Health Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.