Program Specialist, Int. (Pharmacy Management)
CalOptimaCalOptima Health is seeking a highly motivated an experienced
Program Specialist, Int. to join our team. The Pharmacy Program Specialist Int will handle complex assignments and issues, overseeing and coordinating departmental operations and serving as a reference to other pharmacy employees and as a representative of the Pharmacy Management department within CalOptima Health and with other agencies. Under general supervision, the incumbent will complete Pharmacy Management specialized tasks relevant to an assigned program and/or project. The incumbent is responsible for maintaining the Pharmacy Management operations quality assurance program for all CalOptima Health's lines of business and providing training needs assessments based on results. The incumbent will provide general trend information to management and must be able to assist the Compliance department for network audits and Centers for Medicare & Medicaid Services (CMS) audits, as well as research and distribute updates to regulatory guidelines. The incumbent will utilize specialized pharmacy knowledge and expertise to assist participating pharmacies, members, providers, CalOptima Health departments, health networks and other entities to ensure the efficient, timely and effective provision of pharmaceutical products and services to CalOptima Health members. The incumbent will interact with other staff throughout the organization, as well as external contacts. The incumbent will be authorized to make and carry out decisions on behalf of the department within established policies and procedures.
Position Information: - Department: Pharmacy Management
- Salary Grade: 307 - $60,533 - $93,826 ($29.10 - $45.1087)
- Work Arrangement: Full Telework
**This position is eligible for telework in California.**
Duties & Responsibilities: - 85% - Program Support
- Uses a pharmacy computer program to retrieve drug-specific technical data and information necessary for the completion of departmental and interdepartmental pharmacy-related functions and operations.
- Coordinates resolution of provider pharmacy issues requiring specialized technical and professional knowledge and expertise, including pharmacy authorizations.
- Documents member-specific issues and resolutions via the communications log system.
- Resolves claim 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.
- 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 works in conjunction with employees from this department to resolve all pharmacy-related member complaints, including those related to the pharmacy authorization process.
- Serves as the main Pharmacy department liaison to other CalOptima Health departments, major subcontractors and the state on all pharmacy technical operations functions.
- Coordinates the response and resolution to member grievances relating to pharmacy services.
- Coordinates new Pharmacy Management operations program implementations.
- 10% - Administrative Support
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Assists in audits and compliance records requests.
- Serves as liaison for pharmacy claims related questions and with Compliance department on CMS audits.
- Assists in coordination of Pharmacy Management projects and workflows.
- 5% - Completes other projects and duties as assigned.
Minimum Qualifications: - A bachelor's degree in a related field required.
- 4 years of experience as a Pharmacy Technician in the ambulatory, community, home infusion, long term care or managed care setting required.
- PBM claims database and billing systems experience required.
- National Council for Prescription Drug Programs (NCPDP) claims analysis experience 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.
Preferred Qualifications: Required Licensure / Certifications: - Completion of an accredited Pharmacy Technician training program, possessing a registration certificate as a Pharmacy Technician from the California Board of Pharmacy required.
Knowledge & Abilities:
- 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.
Physical Requirements (With or Without Accommodations): - Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) 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
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.
About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!
About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the
2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package.
IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONSApplications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is
June 18, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.
Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.To apply, please visit: https://jobs.caloptima.org/jobs/program-specialist-int-pharmacy-management-505-city-parkway-california-united-states
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