Temp Pharmacy Coordinator

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

Job summary

Santa Clara County Health Plan is seeking a Temp Pharmacy Coordinator in San Jose, California, responsible for reviewing and processing prior authorizations. The ideal candidate will have a high school diploma, an active pharmacy technician license, and at least two years of relevant pharmacy experience.

This temporary position requires strong communication skills, proficiency in software applications, and the ability to work effectively under pressure. The salary range is between $60,111 and $87,161, based on experience and education.

Qualifications

• High School Diploma or GED is required.
• Active Pharmacy Technician License without restriction is required.
• Minimum two years of pharmacy experience in required settings.
• Knowledge of Medi-Cal and Medicare prescription drug benefits.

Responsibilities

• Review and process prior authorizations based on pharmacy guidelines.
• Maintain communication with pharmacies and physicians to solve issues.
• Assist Clinical Pharmacist with various clinical programs.
• Assist with claims processing and troubleshooting.

Skills

Accuracy in tasks

Communication skills

Knowledge of prior authorization

Computer proficiency

Education

High School Diploma or GED

Active Pharmacy Technician License

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Temp Pharmacy Coordinator

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

Temporary Position

FLSA Status: Non-Exempt

Department: Pharmacy

Reports to: Supervisor, Prior Authorization

General Description

The Pharmacy Coordinator reviews and processes prior authorizations based on pharmacy clinical criteria/guidelines. Assists pharmacies and providers in resolving pharmacy claims processing and prior authorization questions in compliance with applicable state and federal regulations, SCFHP policies and procedures, and business requirements. Performs non-clinical duties such as preparing departmental reports and analysis related to formulary management, clinical programs, claims review, audits, and vendor oversight.

Essential Duties and Responsibilities

1. Perform complete, accurate, and consistent prior authorization reviews for medications submitted by providers and/or pharmacies, approving based upon the pharmacy clinical criteria/guidelines.
2. Direct and refer prior authorization requests outside established pharmacy clinical criteria/guidelines to Clinical Pharmacists.
3. Maintain ongoing communication with pharmacies and physician offices, resolve technical processing issues, and elevate outstanding issues.
4. Use appropriate approval and denial language in approval and denial letters.
5. Provide alternatives based on pharmacy clinical guidelines.
6. Assist Clinical Pharmacist with claims reports processing and review.
7. Assist Clinical Pharmacist with pharmacy clinical programs developed within the pharmacy department to outreach to members and/or providers to encourage medication adherence, reduce drug interactions, and enhance the level of care and outcomes for members.
8. Assist Clinical Pharmacist with review of printed formularies, step criteria, and prior authorization guidelines.
9. Assist Clinical Pharmacist with formulary and benefit change submissions.
10. Assist Clinical Pharmacist in DHCS, DMHC, CMS, and department program audits.
11. Follow requirements to maintain compliance and participate in department self-audit procedures.
12. Assist doctors and pharmacies regarding prior authorization approval/denial questions.
13. Assist pharmacy department with claims processing, troubleshooting, and adjudication.
14. Assist customer service and pharmacies with appropriate overrides.
15. Assist pharmacies and providers with member eligibility and primary insurance status and forward information to the appropriate department.
16. Attend and actively participate in daily, weekly, and monthly departmental meetings, in‑services, training, and coaching sessions.
17. Perform other related duties as required or assigned.

Requirements

• High School Diploma or GED. (Required)
• Active Pharmacy Technician License without restriction. (Required)
• PTCB pharmacy certifications. (Desired)
• Minimum two years of pharmacy experience in a managed care, hospital, long‑term care, specialty compounding, infusion center, or retail pharmacy setting. (Required)
• Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (Required)
• Knowledge of prior authorization (PA) or treatment authorization requests. (Required)
• Knowledge of generic and brand name equivalents. Knowledge of Medi‑Cal and Medicare prescription drug benefits and claims processing. (Required)
• Experience processing Medi‑Cal, Medicare Part D, claims and Durable Medical Equipment (DME) authorizations. (Desired)
• Proficient in adapting to changing situations and efficiently alternating focus between tasks to support operations. (Required)
• Working knowledge and ability to efficiently operate all applicable computer software including Outlook, Word, Excel, PBM web‑based platform, and office equipment. (Required)
• Ability to use a keyboard with moderate speed and a high level of accuracy. (Required)
• Excellent communication skills, including clear and concise service over the phone, in person, or in writing. (Required)
• Ability to think and work effectively under pressure and accurately prioritize tasks within established timeframes. (Required)
• Ability to assume responsibility and exercise good judgment when making decisions within scope of position. (Required)
• Ability to maintain confidentiality. (Required)
• Ability to comply with all SCFHP policies and procedures. (Required)
• Ability to perform the job safely and with respect to others, property, and individual safety. (Required)

Working Conditions

Generally performed in an office environment while seated or standing at a desk. Incumbents are subject to frequent contact and interruptions by coworkers, supervisors, and plan members or providers in person, by telephone, and by electronic communications.

Physical Requirements

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

• Mobility Requirements: Regular bending at the waist, reaching overhead and horizontally to retrieve and store files and supplies, and sit or stand for extended periods. (Required)
• Lifting Requirements: Regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds. (Required)
• Visual Requirements: Read information in printed materials and on a computer screen; perform close‑up work at 20 inches or less. (Required)
• Dexterity Requirements: Use hands, wrists, and fingers; perform repetitive motion with keyboard; write or take notes; operate a computer keyboard and other office equipment. (Required)
• Hearing/Talking Requirements: Hear normal speech, converse in person and on telephone. (Required)
• Reasoning Requirements: Think and work effectively under pressure; serve customers; make decisions; maintain concentration on information communicated. (Required)

Environmental Conditions

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

Equal Opportunity Employer

EOE.