Pharmacy Services Specialist - Partial Telework Eligible

CalOptima; Orange (CA); Hybrid; USD 47,000 - 65,000; Part time

Benefits offered by this job

Partial Telework

Flexible scheduling

Professional development opportunities

Career development opportunities

Quality work life balance

Wellness programs

Job summary

CalOptima is seeking an AS-NEEDED Pharmacy Services Specialist to join our Pharmacy Management team in Orange, CA. This role supports member health services, processes prior authorizations, resolutions of pharmacy issues, and program adherence activities.

Partial telework is approved with in-office presence at least two days weekly in Orange as required. You will conduct outbound calls, interpret policies, coordinate with providers and pharmacies, and help improve Star measures while delivering

Qualifications

• High School diploma or equivalent plus 1 year of pharmacy technician experience.
• An equivalent combination of education and experience may qualify.
• Current California Pharmacy Technician license required; PTCB certification is a plus.

Responsibilities

• Conduct outbound calls to members, pharmacies, and providers to improve Star measure performance for medication adherence and other programs.
• Assist with resolution of provider and member pharmacy issues requiring specialized knowledge, including prior authorizations.
• Interpret and articulate Pharmacy Management program policies and procedures to providers and staff.
• Assist in processing pharmacy prior authorization and appeals following CalOptima guidelines.
• Establish and maintain key internal and external contacts to coordinate pharmacy services for members.
• Support department with claims disputes between pharmacies and the claims administrator.
• Complete other projects and duties as assigned.

Skills

Pharmacy operations

Customer service

Outbound calls

Communication

Problem solving

Education

High School diploma

1 year pharmacy technician experience

California Pharmacy Tech license

Tools

Pharmacy software

Microsoft Office

Job description

CalOptima is seeking an AS-NEEDED Pharmacy Services Specialist to join our Pharmacy Management team in Orange, CA. This role supports member health services, processes prior authorizations, resolutions of pharmacy issues, and program adherence activities.

Partial telework is approved with in-office presence at least two days weekly in Orange as required. You will conduct outbound calls, interpret policies, coordinate with providers and pharmacies, and help improve Star measures while delivering