Pharmacy Coordinator

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

Job summary

JobRx, Inc. seeks a Pharmacy Coordinator to support operational, clinical, and regulatory activities within the pharmacy department in California.

The role ensures timely processing of requests, maintains regulatory compliance, and collaborates with internal teams to deliver accurate and efficient member and provider support. The position focuses on denials review, PA processing, quality initiatives, and cross‑functional projects to improve pharmacy operations and member experience.

Qualifications

• High School Diploma or GED.
• Active CA Pharmacy Technician License.
• PTCB certification preferred.
• Minimum two years of pharmacy experience in a managed care, hospital, long‑term care, specialty compounding, infusion center, or retail pharmacy setting.
• Experience in health plan pharmacy operations, pharmacy benefits, prior authorization processes, and Medicare Part D preferred.
• Working knowledge of Outlook, Word, Excel and PBM web based platform and general office equipment.
• Proficient in MS Excel and reports.
• Ability to work independently with minimal supervision while meeting deadlines.
• Excellent communication skills in serving internal departments, members, providers and outside entities.
• Proficient in adapting to changing situations and maintaining accuracy.

Responsibilities

• Conduct daily review of denied pharmacy claims to ensure accuracy and identify trends.
• Perform telephonic member outreach to support Star Measures and follow‑ups on denied PAs and medication refill reminders.
• Support pharmacists by running, validating, and maintaining clinical program reports used for pharmacy quality initiatives.
• Review UM authorization requests for diabetic testing supplies and CGMs.
• Support timely D‑SNP Part D prior authorization effectuations.
• Conduct QA reviews to ensure accuracy for Medicare marketing materials such as network directory and formulary documents.
• Review and support pharmacy grievance cases, ensuring timely resolution and regulatory timeliness.
• Provide responsive support to providers, CSR, and G&A teams regarding pharmacy operations and benefit inquiries.
• Assist with cross‑functional projects that enhance pharmacy operations, compliance, and member experience.
• Perform other related duties as required.

Skills

Communication

Independence

Attention to detail

Confidentiality

Time management

Telephone communication

Education

High School Diploma or GED

Pharmacy Technician License (CA)

PTCB certification

Tools

Outlook

Word

Excel

PBM web platform

Job description

Pharmacy Coordinator

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

FLSA Status: Non-Exempt

Department: Pharmacy

Reports To: Supervisor, Prior Authorization

Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521

General Description of Position

The 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.

Essential Duties and Responsibilities

1. Conduct daily review of denied pharmacy claims to ensure accuracy and 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 quality assurance (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 (R) Desired (D)

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

Working Conditions

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co‑workers, supervisors, and plan members or providers in person, by telephone, and by work‑related electronic communications.

Physical Requirements

1. Mobility Requirements: 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 Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds.
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close‑up work; clarity of vision is required at 20 inches or less.
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note‑taking); ability to operate a computer keyboard and other office equipment.
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone.
6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of 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.

EOE