Pharmacy Quality Coordinator

Job Title: Pharmacy Quality Coordinator
Department: Pharmacy Services Medicare
Job Type: 4 Months contract with Possible extension
Location: Fully Remote - EST/CST

---

Job Summary:

The Pharmacy Quality Coordinator plays a critical role in supporting the Pharmacy Department's STARS Quality Program and broader quality initiatives. Under the general supervision of the Manager of Pharmacy Services, Medicare, this position is responsible for improving member outcomes, ensuring timely access to medications, and providing operational support for pharmacy utilization management. The role involves coordinating with internal departments, pharmacy vendors, and the Pharmacy Benefits Manager (PBM), while also handling escalated member and provider issues related to prescription drug benefits.

---

Key Responsibilities:

• Conduct outreach to members and providers to support quality improvement programs.

• Assist in the implementation of clinical best practices aimed at enhancing member safety, reducing readmissions, and promoting wellness.

• Manage daily operational activities including:

  • Reviewing and resolving claims reject reports.

  • Monitoring transition fill processes.

• Draft and send provider communications to ensure appropriate medication access.

• Serve as a liaison between the pharmacy department and other internal teams (e.g., Appeals and Grievances, Member Services, Care Management) to ensure timely and complete service.

• Educate internal departments about pharmacy processes and procedures.

• Coordinate with the PBM and other pharmacy vendors to resolve escalated issues from members, providers, and pharmacies.

• Support clinical pharmacy staff as needed in delivering high-quality service.

---

Supervision Received:

• Works under general supervision with daily guidance from the Manager of Pharmacy Services.

---

Education Requirements:

• Required: High School Diploma or GED.

• Preferred: Associate's degree or an equivalent combination of education, training, and experience.

---

Experience Requirements:

• Required:

  • Minimum of 2 years of experience in a professional setting.

  • Minimum of 2 years of pharmacy-related experience.

• Preferred/Desirable:

  • Prior customer service experience.

  • Experience working in a managed care setting, especially in Medicaid and/or Medicare programs.

Education Required:
HS Diploma or GED required.




.