Job Details

Pharmacy Services QM Associate

Company name
Centene Corporation

Rego Park, NY, United States

Employment Type

Bluecollar, Healthcare

Posted on
Feb 14, 2020

Valid Through
May 29, 2020

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Pharmacy Services QM Associate','1174939','!*!Position Purpose: Supporting multiple pharmacy quality initiatives, including the Restricted Recipient Program and QARR/HEDIS.Maintain Restricted Recipient Program (RRP) by updating restrictions as they are modified, deleted, or added in conjunction with multiple Fidelis departments.Respond to RRP provider changes in a timely manner to ensure appropriate service accessibility.Support Restricted Recipient Evaluation Committee (RREC) through report retrieval for potential and existing RRP members, preparing and distributing monthly meeting material, and taking meeting minutes.Seek opportunities in executing multidisciplinary collaborations with the Special Investigations Unit and the Office of Medicaid Inspector General (OMIG) in identifying and minimizing overutilization, misutilization, or fraud/waste/abuse of Medicaid benefits.Assist in annual QARR/HEDIS surveys in gathering review materials, including supplemental data and roadmap requirements.Collaborate with IT to send out notifications to providers and members as necessary for QARR/HEDIS related projects.Make outbound calls to members and providers related to QARR/HEDIS and Article 49.','!*!Education/Experience: High School Diploma, required. AA/AS - Associates Degree or BS in a health related field, preferred. Two years’ experience as a Pharmacy Technician Preferred. Experience performing medication authorizations in a pharmacy or managed care environment. Understanding of QARR/HEDIS standards and measure. Experience participating in Federate, State, and Compliance audits pertaining to fraud, waste, and abuse Experience in investigative reviews and resolution. Experience working in a monitored, fast-paced, high volume, environment with responsibility for both incoming and out-going calls, preferred. Proficiency in Microsoft Office: Excel, Word, Access; Outlook, Internet.License/Certification: PTCB or ExCPT Pharmacy Technician Certification, requiredCentene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.','Pharmacy','USA-New York-Rego Park','','Fidelis Care','Full-time','','false','Pharmacy Services QM Associate

Company info

Centene Corporation
Website :

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