Supervisor, Pharmacy Quality (52487)

About Us

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company—we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative, and who have a passion for continuous learning.

About You

Performs tasks associated with quality initiatives to improve member care. Ensures the effective management of care gaps, including data entry, referral tracking, and telephonic member and provider outreach. Provides direct supervision for assigned Clinical Quality Specialists.

Responsibilities

• Oversees assigned Clinical Quality Specialists by conducting performance evaluations, communicating team goals and deadlines, and providing training and direct oversight to ensure quality and compliance.
• Coordinates time management for assigned Clinical Quality Specialists including timesheet and absence approvals.
• Supports and maintains outreach initiatives with members and providers.
• Effectively educates providers on quality metric guidelines to enhance patient compliance.
• Oversees assigned geographic area for scheduling record audits at remote provider offices.
• Conducts record audits at remote provider offices.
• Performs accurate data entry in HEDIS software system and outreach tracking system.
• Reviews and maintains medical records to identify, confirm, and/or document referrals, results, and appropriate medical coding.
• Maintains detailed technical understanding of HEDIS, CAHPS, HOS, and Meaningful Use measures set by CMS performance standards.
• Maintains confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned.

Requirements

• High School diploma or equivalent required.
• Current Certified/Registered Medical Assistant in State of Oklahoma and one year of experience with a health plan or within a quality department or clinical setting required. Will consider an additional 6 months of experience with a health plan or within a quality department or clinical setting in lieu of Certification.
• Previous supervisor or lead experience preferred.
• Associate degree or equivalent coursework completed preferred.
• Valid state Driver’s License, reliable personal vehicle, and proof of personal vehicle liability insurance required.

Skills

• Computer literate and familiar with Microsoft applications (Word, Excel).
• Basic electronic health record knowledge and ability to quickly learn new software.
• Detailed knowledge of quality performance measures and clinical health care.
• Strong organizational and time management skills.
• Strong verbal and written communication skills.
• Ability to effectively manage a team, including defining and setting priorities.

Working Conditions

• Current work environment is remote; however, some state exclusions apply. Must have access to a reliable and secured internet connection source.
• Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure, or damage and will adhere to all GlobalHealth privacy and security policies.

Travel

Travel required up to 75% of the time January–June. Occasional travel required outside of audit season. Overnight stays possible.

Supervisory Responsibility

Supervises work of others, including planning, assigning, and scheduling work, reviewing work and ensuring quality standards, training staff, and overseeing their productivity. May offer recommendations for hiring, termination, and pay adjustments, but does not have responsibility for making these decisions.