Pharmaceutical Care Specialist

2 weeks ago


Corpus Christi, Texas, United States Optum Full time

Key Responsibilities:
This role encompasses a blend of telephonic patient engagement to conduct assessments and provider-facing activities, both virtually and in-person, collaborating with market representatives.
Formulate strategic market business plans aimed at encouraging providers and leadership of large or complex groups to enhance Stars measures, striving for a minimum of 4 STARS in pharmacy-related metrics such as Statin Use in Patients with Diabetes, Statin Use in Patients with Cardiovascular Disease, and Medication Adherence for Diabetes, Cholesterol, and Hypertension.
Deliver analytical insights on Stars and HEDIS reporting, providing executive summaries to planning and provider groups regarding pharmacy measures, including best practices and strategies to overcome patient barriers.

Act as the primary subject matter expert for all STARS-related initiatives within designated markets, working collaboratively within a matrix structure that includes Quality corporate operations and Regional/Market operations.

Lead or engage in weekly, monthly, bi-monthly, quarterly, and/or annual business review meetings concerning STAR activities, summarizing provider and large group performance as well as market performance as requested by Quality or Regional leadership.

Evaluate provider and large group structures, operations, and personnel to identify the most effective strategies and approaches.
Assist in the creation of training and analytical resources for Stars and HEDIS.
Identify and evaluate key decision-makers and personnel within provider groups, focusing on recognizing barriers to achieving targeted outcomes and tailoring communications and efforts accordingly.
Develop innovative, user-friendly initiatives to foster practice success.
Conduct outbound calls to members to gather information regarding HEDIS and Quality measures related to their care, as well as to identify any potential gaps in care.
Perform annual medication reviews of both prescription and non-prescription medications, emphasizing patient assessment and counseling, safe and effective medication use, and identification of potential drug interactions.
Conduct pharmacotherapy assessments based on patients' claims, medical history, and disease states.
Assess patients for barriers to medication adherence and devise plans to enhance their medication success through improved adherence.
Provide patient-centered, clinically collaborative medication consultations.
Create a post-consultation action item list for the patient and/or prescriber.
Maintain a high level of clinical expertise regarding chronic disease states and advancements in pharmacy practice for adult and geriatric populations, serving as a reliable information source on drug utilization in therapy.
Perform all other related duties as assigned.

Qualifications:
Doctor of Pharmacy degree or equivalent experience.
Must possess an active, unrestricted pharmacy license in Texas.
Minimum of 5 years of clinical pharmacy practice experience.
At least 2 years of experience with Medicare STARs & HEDIS measures.
Minimum of 2 years of experience in provider-facing interactions, including provider education.
At least 2 years of experience in data analysis and/or quality chart reviews, with the ability to review data and offer improvement recommendations.
1+ years of call center experience.
Proficient in Microsoft Word, Excel, Outlook, and PowerPoint.
Comfortable operating in a fast-paced and highly matrixed environment.
Located or within driving distance of the market being supported.

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