Pharmacy Coordinator

Essential Duties And Responsibilities

• Cover daily review of denied pharmacy claims to ensure accuracy and identify trends.
• Perform telephonic member outreach to support Star Measures, including 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 continuous glucose monitors (CGM).
• Support timely D-SNP Part D prior authorization effectuations.
• Conduct quality assurance (QA) reviews to ensure accuracy for Medicare required marketing materials such as pharmacy network directory and formulary documents.
• Review and support pharmacy grievance cases, ensuring timely resolution and compliance with regulatory timelines.
• Provide responsive support to providers, Customer Service Representatives (CSR), and G&A teams regarding pharmacy operations and benefit inquiries.
• Aid with various cross-functional projects that enhance pharmacy operations, compliance, and member experience.

Requirements

• High School Diploma or GED.
• Current and active Pharmacy Technician License without restriction in CA.
• PTCB pharmacy certifications.
• 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 and the ability to efficiently operate all applicable computer software including 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 consistently meeting deadlines and performance expectations.
• Ability to use a keyboard with moderate speed and a high level of accuracy.
• Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing.
• Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs.
• Ability to use telephone systems to place and receive calls in a professional manner.
• Ability to maintain confidentiality and comply with all SCFHP policies and procedures.
• Ability to perform the job safely and with respect to others, to property and to individual safety.