Pharmacy Coordinator

Santa Clara County Health Plan; San Jose (CA); On-site; USD 60,111 - 87,161; Full time

Job summary

Santa Clara County Health Plan is seeking a Pharmacy Coordinator to support operational, clinical, and regulatory functions in the pharmacy department. The role includes ensuring timely processing of requests and maintaining compliance with regulations.

Salary ranges from $60,111 to $87,161 based on experience and education. Responsibilities include reviewing pharmacy claims and member outreach. Strong communication and pharmacy experience are essential for this position.

Qualifications

• High School Diploma or GED required.
• Current and active Pharmacy Technician License without restriction in California.
• Two years of pharmacy experience in a relevant setting.

Responsibilities

• Conduct daily review of denied pharmacy claims.
• Perform telephonic member outreach for support.
• Review UM authorization requests for diabetic testing supplies.

Skills

Pharmacy experience

Communication skills

Time management

Computer software proficiency

Education

High School Diploma or GED

Pharmacy Technician License (CA)

Tools

Excel

PBM web-based platform

Job description

Position Summary

Pharmacy Coordinator supports key operational, clinical, and regulatory functions across the pharmacy department. This role ensures timely processing of pharmacy-related requests, maintains compliance with regulatory requirements, supports quality and Stars initiatives, provides operational oversight of pharmacy benefit functions, and collaborates with internal teams to ensure members and providers receive accurate and efficient support.

Compensation

Salary Range: $60,111 - $87,161. The range is based on factors such as experience, education, and the market and may be subject to change.

Job Details

FLSA Status: Non-Exempt

Department: Pharmacy

Reports To: Supervisor, Prior Authorization

Union Representation: Service Employees International Union (SEIU) Local No. 521

Essential Duties and Responsibilities

1. Conduct daily review of denied pharmacy claims to ensure accuracy, identify trends, and intervene as needed.
2. Perform telephonic member outreach to support Star Measures, including follow-ups on denied PAs and medication refill reminders.
3. Support pharmacists by running, validating, and maintaining clinical program reports used for pharmacy quality initiatives.
4. Review UM authorization requests for diabetic testing supplies and continuous glucose monitors (CGM).
5. Support timely D‑SNP Part D prior authorization effectuations.
6. Conduct QA reviews to ensure accuracy for Medicare-required marketing materials such as pharmacy network directory and formulary documents.
7. Review and support pharmacy grievance cases, ensuring timely resolution and compliance with regulatory timelines.
8. Provide responsive support to providers, Customer Service Representatives (CSR), and G&A teams regarding pharmacy operations and benefit inquiries.
9. Assist with various cross‑functional projects that enhance pharmacy operations, compliance, and member experience.
10. Perform other related duties as required or assigned.

Requirements

Required:

1. High School Diploma or GED.
2. Current and active Pharmacy Technician License without restriction in CA.
3. Minimum two years of pharmacy experience in a managed care, hospital, long‑term care, specialty compounding, infusion center, or retail pharmacy setting.
4. Experience in health‑plan pharmacy operations, pharmacy benefits, prior authorization processes, and Medicare Part D preferred.
5. Working knowledge and ability to efficiently operate applicable computer software including Outlook, Word, Excel, and PBM web‑based platform.
6. Ability to work independently with minimal supervision while consistently meeting deadlines and performance expectations.
7. Ability to use a keyboard with moderate speed and high level of accuracy.
8. Excellent communication skills when providing service to internal departments, members, providers, and external entities over the telephone, in person, or in writing.
9. Proficient in adapting to changing situations and efficiently alternating focus between tasks to support operations as dictated by business needs.
10. Ability to effectively use telephone systems to place and receive calls in a professional manner.
11. Ability to maintain confidentiality and comply with all SCFHP policies and procedures.
12. Ability to perform the job safely and with respect to others, property, and individual safety.

Desired:

1. Pharmacy Technician Board (PTCB) certifications.
2. Proficient in MS Excel and reports.

Working Conditions

Generally performed in an office environment while sitting or standing at a desk. Regular interaction with co‑workers, supervisors, and plan members or providers in person, by telephone, and via work‑related electronic communications.

Physical Requirements

1. Mobility: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time.
2. Lifting: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds.
3. Visual: ability to read information in printed materials and on a computer screen; perform close‑up work; clarity of vision at 20 inches or less.
4. Dexterity: regular use of hands, wrists, and finger movements; repetitive motion (keyboard); writing (note‑taking); operate a computer keyboard and other office equipment.
5. Hearing/Talking: ability to hear normal speech and communicate over telephone.
6. Reasoning: ability to think and work effectively under pressure; effectively serve customers; decision making; maintain concentrated attention to information communicated in person and by telephone throughout a typical workday; attention to detail.

Environmental Conditions

General office conditions. May be exposed to moderate noise levels.

Equal Opportunity Employer

We are an Equal Opportunity Employer.