As part of the Member Outreach team in QM, the Medication Management Coordinator outreaches directly to members and handles inbound calls related to monitor medication adherence. This may include assisting the member to obtain prescribed medications.
Utilize health plan and internal reporting to identify members in medication adherence denominators and use this as a basis for outreach to ensure that members have needed access to prescribed medications
Document attempts to reach members and outcome of calls in Cozeva and/or sPHERICAL Solutions
Provide members with information regarding health plan incentive programs as applicable
Provide members with various routes for obtaining medications including contracted pharmacies and home delivery programs
Promote utilization of 100-day medication supplies so medication refills can be reduced to 3x a year from 4x
Attend and engage in health plan JOMs and QM meetings when medication adherence will be part of the discussion
Work directly with health plan pharmacists when requested to discuss special pharmacy programs and/or member engagement in the program
Develop innovative methods to encourage member medication adherence
Encourage providers to perform medication reconciliation following member hospitalization
Provide updates to HEDIS/STARs Specialists
Obtains records from EHR systems if access available
Safeguard the patient records and ensure that the procurement process is in compliance with HIPPA standards
Assist HEDIS/STARs Specialists on special projects as needed
Additional projects in the Quality Management department as required
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