Clinical Quality Pharmacist

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Clinical Quality Pharmacist is responsible for creating and implementing data‑driven, pharmacy‑based strategies and workplans that improve the health, well‑being, and quality of care and service received by our members. Success in this role is demonstrated by high quality measure performance in Medicare Part D and pharmacy‑based HEDIS and CMS Star measures, with an emphasis on medication adherence, appropriate therapy initiation, and high‑risk medication use reduction. This role uses outreach, education, care reminders, and prescription (Rx) prescribing support to engage patients and providers on the importance of medication therapy and adherence. The Clinical Quality Pharmacist collaborates with internal and external stakeholders, regional operations, IPA practices, employed sites, health plan payors, and other community partners to strengthen clinical relationships and engagement between members and the care delivery system. The focus of this position is to support and manage pharmacy‑based quality metric performance, including but not limited to HEDIS, CMS Star Ratings, Medicare Part D gap closure, and CAHPS/HOS patient experience performance. The ideal candidate will be: Self-directed, able to manage multiple priorities, and coordinate complex cross-functional project plans, to drive execution of strategies Accountable for demonstrating improvement in quality, patient experience and optimized patient outcomes Skilled at utilizing data to drive decisions and has a passion for applying technology to achieve systematic solutions Passionate about continuous improvement, streamlined processes and workflow optimization Energized by new challenges, thrives in a fast-paced, dynamic environment, collaborates well in a collaborative atmosphere Primary Responsibilities: Under direction of the Medical Director, Quality Improvement and in collaboration with other stakeholders, the Clinical Quality Pharmacist will lead implementation of strategic pharmacy-based programs that improve the overall health and service provided to our patients. The goals of the program may include but is not limited to: Patient outreach and education (e.g., patients at risk of falling out of medication compliance for one or more medications, newly prescribed Statin Rx, PCP referrals) Managing patient outreach registries Counselling and educating patients regarding pharmacy benefits, health plan network and other programs and tools available to help improve quality of lifestyle Establishing a plan for each patient and/or patient opportunity cohort Coordinating auto Rx refills, multi-month Rx conversions, and mail order Rx Discussing patients' life issues affecting medication adherence and providing advice on improving drug regimen compliance Advising patients on alternate Rx fill strategies of retail versus mail order and options for financial assistance Provider/Clinician engagement to targeted clinicians with high volumes of patients with Part D Rx gaps and those needing education on the new Polypharmacy: Use of Multiple Anticholinergic (ACH) Medications in Older Adults, Concurrent Use of Opioids and Benzodiazepines, and additional emerging drug‑related quality metrics as assigned Providing clinician education on measure requirements Reviewing strategies to reinforce Rx therapy and support Medication Adherence Offering clinician prescribing assistance, such as Prescribing Protocol Agreements to initiate / modify Rx on their behalf Liaising with provider offices on labs, refill orders and prior authorizations Reviewing and advising on medications and treatment plans (based on review of medical case notes, medication list and lab results) to improve outcomes and avoid potential drug interactions Outreaching