Pharmacy Operations & Compliance Specialist

JobRx, Inc.; 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

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.