Y AS-NEEDED - Pharmacy Services Specialist

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

Y AS-NEEDED - Pharmacy Services Specialist

CalOptima

Join Us in this Amazing Opportunity

The Team You'll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a AS-NEEDED Pharmacy Services Specialist and help shape the future of healthcare where you'll be an integral part of our Pharmacy Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework.

- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 85% - Program Support
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Conducts outbound calls to members, pharmacies, and providers in an effort to improve Star measure performance for medication adherence and other Star programs as needed.
• Using a pharmacy computer program, retrieves drug-specific technical data and information necessary for the completion of departmental and interdepartmental pharmacy-related functions and operations.
• Assists with resolution of provider and member pharmacy issues requiring specialized technical and professional knowledge and expertise, including pharmacy authorizations.
• Supports the department with claims disputes between providing pharmacies, the pharmacy claims administrator, CalOptima Health Claims Department and other entities as necessary.
• Interprets and articulates Pharmacy Management program policies and procedures to pharmacy providers, other providers, other CalOptima Health staff, external agencies and others as required.
• Assists in the processing of pharmaceutical prior authorization and appeals requests as per the CalOptima Health Prior Authorization Guidelines as needed.
• Establishes and maintains key contacts both internally and externally to assure appropriate coordination and provision of pharmacy services to CalOptima Health Members.
• Accepts referrals from Member Services and work in conjunction with employees from this department to resolve all pharmacy-related member complaints, including those related to the pharmacy authorization process.
• Assists pharmacies and health plans in resolving member-specific pharmacy services access issues, removing barriers to access to pharmaceutical services.
• Identifies pharmacy-related resources and recommend new procedures, processes or activities that help assure the efficient provision of pharmacy services to members.
• 10% - Administrative Support
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Maintains documentation of the Stars adherence program and other Stars program outreach according to the internal guidelines.
• 5% - Other
• Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• High School diploma or equivalent PLUS 1 year of experience as a pharmacy technician required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

You’ll Stand Out More If You Possess the Following:

• Associate degree in a health-related field.
• Pharmacy Technician Certification Board (PTCB).
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

What the Regulatory Agencies Need You to Possess?

• A current, valid, unrestricted California Pharmacy Technician license required.

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (unencinate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You’ll enjoy competitive compensation for this role.
• Our current hiring range is: Pay Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500).
• The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
• This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**)
• Additional benefits and perks including:
• A quality work life balance
• Various wellness programs
• Professional development opportunities
• Career development opportunities
• Flexible scheduling
• And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

What's Your Next Step?

All Applications will be accepted on a continuous basis until a sufficient