Y AS-NEEDED - Pharmacy Services Specialist

We are a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person.

About the role

Join our Pharmacy Management team as an As-Needed Pharmacy Services Specialist. This position is approved for partial telework, requiring work within the State of California and in-office attendance in Orange, CA at least two days per week.

Responsibilities

• Program Support (85%)
  • Participate in a mission-driven culture focused on high-quality performance, customer service, consistency, dignity, and accountability.
  • Conduct outbound calls to members, pharmacies, and providers to improve Star measure performance for medication adherence and other Star programs.
  • Retrieve drug-specific technical data using pharmacy computer programs to support departmental and interdepartmental functions.
  • Resolve provider and member pharmacy issues requiring specialized technical and professional knowledge, including pharmacy authorizations.
  • Support claims disputes between pharmacies, the pharmacy claims administrator, CalOptima Health Claims Department, and other entities.
  • Interpret and articulate Pharmacy Management program policies and procedures to providers, staff, external agencies, and others.
  • Process pharmaceutical prior authorization and appeals requests according to CalOptima Health Prior Authorization Guidelines.
  • Establish and maintain key internal and external contacts to coordinate pharmacy services for members.
  • Accept referrals from Member Services and resolve pharmacy-related member complaints, including authorization process issues.
  • Assist pharmacies and health plans in resolving member-specific pharmacy access issues and removing barriers.
  • Identify pharmacy-related resources and recommend new procedures or activities to improve service efficiency.
• Administrative Support (10%)
  • Assist the team in carrying out department responsibilities and collaborate on short- and long-term goals.
  • Maintain documentation of Stars adherence programs and outreach according to internal guidelines.
• Other (5%)
  • Complete additional projects and duties as assigned.

Requirements

• High School diploma or equivalent plus 1 year of experience as a pharmacy technician; or an equivalent combination of education and experience.
• Current, valid, unrestricted California Pharmacy Technician license.

Qualifications

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

Skills

• Develop rapport and maintain effective working relationships with diverse internal and external contacts.
• Work independently with sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule, including evenings and weekends.
• Organize, analyze, problem-solve, and manage projects efficiently.
• Work in a fast-paced environment and manage multiple projects.
• Identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees.
• Proficient in Microsoft Office (Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Physical Requirements

• Ability to visually read information from computer screens, forms, and printed materials.
• Clear speech for communication via telephone and face-to-face interactions.
• Hearing ability for verbal communication.
• Manual dexterity for typing, writing, standing, reaching, flexibility, and body movement (bending, crouching, walking, kneeling, prolonged sitting).
• Lifting and moving objects, patients, or equipment weighing 10 to 25 pounds.

Pay

Pay Grade: 301 - $47,840 - $64,584 per year ($23.00 - $31.05 per hour). The final salary offered will be based on education, job-related knowledge, experience, skills, and internal equity.

Benefits

• Work-life balance.
• Wellness programs.
• Professional and career development opportunities.
• Flexible scheduling.
• Satisfaction of impacting and improving healthcare access for thousands of individuals and families.

Schedule

This position requires availability to participate in evening and weekend events as needed.

Work Environment

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

• Typically indoors and sedentary, subject to schedule changes and variable work hours, with travel as needed.
• No harmful environmental conditions; moderate noise level.

If located at PACE:

• Typically indoors in a clinical setting serving the frail and elderly.
• May involve harmful or hazardous environmental conditions; moderate to loud noise level.

If located in the community:

• Typically indoors and sedentary, subject to schedule changes and variable work hours, with travel as needed.
• Occasional outdoor work in varied temperatures.
• May involve harmful or hazardous environmental conditions; moderate to loud noise level.