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Role Description

The Pharmacy Care Specialist will be primarily responsible for providing supportive care and assistance to a diverse patient population. This individual will be responsible for ensuring members are taking their medications as prescribed, understand their prescription benefits, and have the resources to obtain and pay for their medications. They will be a key part of our interdisciplinary team in identifying and removing social determinants of health and empowering our members to be involved in their healthcare journey.

• Conduct outbound phone calls to members to identify care needs and to determine appropriateness for participation in care coordination programs
• Outreach to members, providers, and pharmacies to discuss alternative medications, costs savings opportunities and adherence needs to improve HEDIS and STAR measures
• Contact patients, pharmacists and doctor's offices to research and resolve rejected and failed claims issues
• Work collaboratively with patients, network providers, pharmacist, referral coordinators, office and hospital staff; document all activities
• Report observations, symptoms and behaviors to appropriate healthcare professionals to ensure timely and effective intervention; Pharmacy Care Specialists are prohibited from conducting evaluations or interpretations of clinical data
• Collect and analyze health plan data needed to implement and monitor quality improvement
• Helping identify members who may be at-risk for medication non-adherence; identifying and acting to address specific drivers of medication non-adherence
• Schedule member appointments with our clinical pharmacist or complex care team for medication adherence issues or medication reconciliation
• Additional quality-related activities as identified that will improve patient and provider engagement and performance (preventive care visit, health screening and post-discharge related outreach)

Qualifications

• Pharmacy Technician License or Nationally Certified Pharmacy Technician
• Other certifications that may be considered include Certified Medical Assistant (CMA), Certified Nursing Assistant (CNA), Emergency Medical Technician (EMT)
• Associate degree in healthcare or a related field of study; or, an equivalent combination of education and/or experience
• Minimum three (3) years of experience in a directly related position in the healthcare industry with high level of comfort around pharmacy & medical terminology
• Demonstrated experience caring for Medicare patients with a strong desire to work closely with aging patient populations
• Experience with pharmacy related quality assurance (e.g., medication reconciliation following hospital discharge and coordinating prescription refill programs)
• Excellent verbal, written and interpersonal communication skills; highly collaborative team approach to work
• Proficiency with Microsoft Excel and web-based technologies. Comfort using laptops, tablets and other electronic and portable devices for documentation

Preferred Skills & Qualifications

• Bilingual – able to speak, read and write clearly and concisely in English and Spanish
• Previous experience with responsibility for pharmacy benefit management (PBM) or health plan managed care systems
• Experience with Medicare Part D operations (e.g., pharmacy help desk, utilization management, formulary management)
• Demonstrated knowledge and understanding of HEDIS metrics
• Experience working with a diverse population and a strong understanding of multicultural issues
• Strong problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Successful record of managing multiple projects with demonstrated ability to work independently in rapidly changing environments

Company Description

Equality Health is an integrated, holistic, and tech-enabled healthcare delivery system focused on improving the health and wellness of diverse populations. Founded in 2015, Equality Health aims to improve access to value-based care for people who have long struggled with navigating the traditional one-size-fits-all U.S. healthcare system. The mission of the company is to provide high-quality care that improves and enhances lives regardless of race, ethnicity, age, or income.

• Through its supplemental care management services and proprietary technology platform, CareEmpower™, Equality Health helps managed care plans and health systems improve outcomes and lower costs for diverse populations while simultaneously facilitating the transition to risk-based accountability.
• Equality Health supports over 800,000 members and more than 4,000 practice sites and continues to scale rapidly.
• In 2021, Equality Health partnered with General Atlantic, a leading global growth equity firm, to help drive continued expansion and fuel the next phase of growth as a leading value-based primary care network serving the Medicaid, Medicare and ACA Exchange populations.
• This strategic investment will enable Equality Health to pursue further geographic expansion, technological innovation and product development while furthering its mission of increasing access to care, lowering costs and improving outcomes for underserved individuals, families and communities.