Career Opportunities: Pharm Benefits Coordinator I (24631)

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Position Title:               Pharmacy Benefit Coordinator I

Requsition #:                24631

Department:                 Pharmacy

Title of Manager:          Pharmacy Manager

Supervises                    Non-Supervisory Position

Exemption Status:        Exempt

Pay and Benefits:           Pay and Benefits:          Estimated hiring range $64,130 - $78,390/ year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits

Posting Notes:                Posting Notes:              This fully remote position has a flexible schedule of five 8-hour shifts or four 10-hour shifts. You must reside in one of the listed 9 states.

                                      This position will focus on Medicare Part D (pharmacy). Strong knowledge of CMS guidelines and Medicare Part D are highly preferred.

                         Please submit a cover letter to be considered.

General Statement of Duties

This position is accountable for providing project implementation, oversight and maintenance for the day-to-day operations of pharmacy benefit management for key lines-of-business, clients and/or initiatives.  There is a particular focus on ensuring the pharmacy benefit is accurately coded and meets regulartory and contractual compliance. The Pharmacy Benefit Coordinator I responds to external customer and internal staff/departments needs regarding pharmacy benefits.

Essential Position Functions

• Manage small to medium projects to implement pharmacy formulary and benefit changes. This would include gathering requirements, communicating milestones and barriers, creating timelines and meeting deadlines, meet regulatory requirements, and updating stakeholders.
• Regularly interface with the Pharmacy Benefit Manager (PBM) to implement, validate and trouble shoot pharmacy benefit claims processing functions and coding to meet the pharmacy benefit set-up and maintenance requirements.
• Assist in performing delegation oversight functions of the PBM to ensure that contractual and regulatory requirements are met

• Develop pharmacy data reports for utilization review, formulary and benefit member impact, data validation, universe tables, and audit and monitoring purposes. 

• Facilitate with an analyst and/or perform pharmacy data analysis directly to develop, test, monitor and confirm a successful implementation and monitoring plan for pharmacy department assignments.
• Represent the pharmacy department at key implementation, client support and operational meetings regarding the status and function of the pharmacy benefit.
• Act as a point of contact for Pharmacy Benefit Specialists with questions regarding benefits, claims, prior authorizations, and appeals.
• Respond to escalated calls from pharmacy department staff to investigate and trouble shoot formulary and benefit issues and provide solutions.
• Assist the Pharmacy Operations Manager and Supervisor(s) with monitoring productivity, work distribution, quality monitoring and performance evaluations.  This role includes mentoring and serving as a role model for new or existing Pharmacy Benefit Specialists.
• Work collaboratively with other CareOregon departments and Medical Management units on process improvement projects and inter-departmental work teams.
• Independently manage special projects and duties as assigned by department leadership to support department goals and metrics.
• Consistently meet or exceed Department and Company policies including but not limited to quality, production, attendance and conduct.

• Learning to see the big picture beyond a request and taking appropriate holistic action, employing “systems thinking”.

Essential Department and Organizational Functions

• Propose and implement process improvements.
• Meet deadlines for completion of workload.
• Maintain agreed upon work schedule.
• Demonstrate cooperation and teamwork.
• Provide cross-training on specific job responsibilities.
• Meet identified business goals that contribute to departmental goals.
• Perform other duties as needed.

Knowledge, Skills and Abilities Required

• Knowledge of and ability to work with Medicaid, Medicare and Special Needs members preferred
• Knowledge of or ability to learn how to research, understand and interpret federal and state requirements, including the Code of Federal Regulations, Oregon Revised Statutes and Administrative Rules, HIPAA, and Medicare Advantage Manuals and related guidance
• Ability to use good judgment, personal initiative and discretion to perform job responsibilities
• Ability to monitor and recognize questions, tasks or workflows for work that requires a pharmacist professional judgment and ensure pharmacists are asked for assistance
• Knowledge of medical, pharmaceutical and managed care terminology
• Excellent interpersonal and customer service skills
• Strong written and verbal communication and documentation skills
• Effective reporting and analytical skills
• Ability to implement projects and to train staff to new processes and procedures
• Ability to learn and use CareOregon and PBM software programs necessary to perform job responsibilities
• Ability to work autonomously with strong problem solving, organizational and detail orientation skills
• Ability to organize, plan, and prioritize daily workflow and projects within time constraints.
• Ability to work in an environment with diverse individuals and groups
• Ability to commit to process improvement, employee development, and personal growth
• Learn to see the big picture beyond a request and taking appropriate holistic action, employing “systems thinking”

Physical Skills and Abilities Required

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

• Minimum 2 years’ relevant pharmacy benefit experience, such as a pharmacy benefit specialist or coordinator
• Experience with spreadsheet and basic data file manipulation for the purpose of testing and validating pharmacy benefit set-ups and maintenance

Preferred:

• Experience in pharmacy claims processing, coding and pharmacy benefit data analysis
• Experience in Medicaid, Medicare and Commercial pharmacy benefit administration

Working Conditions

• Environment:  This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):

☒ Inside/office                 ☐ Clinics/health facilities              ☐ Member homes

☐ Other_________________________________________

• Travel:  This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
• Equipment:  General office equipment and/or mobile technology
• Hazards:  n/a

#MULTI

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.