Clinical Quality Pharmacist

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 170+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.

HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a Clinical Quality Pharmacist in our Garden City Office!

Position Summary: The Clinical Quality Pharmacist supports the MSO by optimizing medication use, improving quality performance, and enhancing patient outcomes across Medicare, Medicaid, and Commercial lines of business. This role focuses on quality measure performance, medication adherence, gaps in care, and provider education.
The pharmacist serves as a clinical subject matter expert, collaborating with providers, care management, pharmacy technicians, and internal teams to close quality gaps, ensure appropriate medication use, and support improved gap closure through both operational and clinical initiatives. Responsibilities include medication reconciliation, adherence interventions, and provider-facing education related to HEDIS, Medicare Stars, QARR, and other quality programs.

Essential Position Functions/Responsibilities:

• Contribute to achieving excellent performance on quality pharmacy measures, such as medication adherence, polypharmacy, and other core quality measures.
• Educate providers and their office staff on relevant clinical guidelines and maintain knowledge of clinical standard of care updates for Quality gap closure.
• Perform root cause analysis for coding/documentation inaccuracies; create work plans per provider to measure office progress as needed.
• Initiate, facilitate and attend provider meetings to provide feedback on coding and chart documentation improvements, successes and raise issues and concerns to ensure optimal outcomes and appropriate follow up.
• Collaborate with healthcare providers and patients to update medication regimens and resolve discrepancies.
• Assist members in improving medication adherence through patient education, counseling, and developing personalized adherence plans.
• Remains current with and monitors all State, Health Plan, NCQA, and other regulatory bodies to ensure compliance with the Quality department.
• Collaborate with providers, specialty pharmacies, and members to ensure optimal therapy outcomes.
• Retain Provider Partnerships; provide education to providers and office staff on Quality Measures and appropriate documentation techniques as appropriate.
• Partner with Network, Quality Field Specialists and other Provider focus teams to maximize member outreach for preventive services a, as needed.
• Assist in developing member and/or provider educational materials in relation to HEDIS, Medicare Stars, QARR and/or other health communications.
• Serve as subject matter expert on Quality Measures and clinical guidelines for the Quality Team.
• Educate healthcare providers and members on medication management, adherence strategies, and potential drug interactions.
• Develop educational materials and participate in training sessions to enhance medication-related knowledge for Quality staff, providers, and members.

Qualification Requirements:
Skills, Knowledge, Abilities

• Clinical pharmacy experience in a healthcare or managed services organization setting is preferred
• Experience with medication reconciliation, medication adherence programs, and chronic disease management
• Understanding of quality measures related to medication management and pharmacy utilization
• Excellent communication skills to effectively interact with healthcare providers, patients, and interdisciplinary teams
• Strong analytical and problem-solving abilities to interpret and evaluate complex medication-related data
• Ability to work independently, prioritize tasks, and manage multiple responsibilities
• Continuous learning mindset to stay updated with emerging pharmacy practices, guidelines, and regulations

Training/Education:

• Doctor of Pharmacy (PharmD) degree from an accredited institution is required

• Current pharmacist licensure in the state of New York
• Certification in CRC (Certified Risk Adjustment Coder) is required and must be maintained in active status. If not obtained prior to hire, the certification must be completed within the first 120 days of employment.
• Completion of a pharmacy residency is preferred

Experience:

• Minimum of five years of management experience in a managed care environment
• Minimum of three years in medication management
• K n o w l e d ge o f H E DI S / QARR r e qu i r em en t s for Medicaid li n e of business i n c ludi n g med i c a l rec o rd review a n d /or reporting p r oc e s s e s, p r ef e r r ed
• Experience with quality measures
• Experience with provider/member/staff education

Base Compensation; $120,000 - $135,000 annually

Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.