Job Description

Client: Health

Job Title: Pharmacy Technician

Duration: 06+ Months

Start Date: ASAP

Location: 505 City Parkway West, Orange CA (100% Onsite)

Position Type: Contract

Interview Type: Web Interview

Department: Pharmacy Management

Description:

• The Pharmacy Services Specialist will utilize specialized pharmacy knowledge and expertise to assist participating pharmacies, members, providers, CalOptima Health departments, health networks and other entities in assuring the efficient, timely and effective provision of pharmaceutical products and services to CalOptima Health members. The incumbent will interact with other department staff throughout the organization, as well as external contacts daily. The incumbent is responsible for ongoing public contacts including, but are not limited to, members, individual pharmacies, member advocates, family members, health networks, Public Guardian’s Office, Regional Center and other agencies.
• CalOptima Health is seeking a highly motivated an experienced Pharmacy Services Specialist (Clinical Programs-Stars) to join our team. The Pharmacy Services Specialist will utilize specialized pharmacy knowledge and expertise to assist participating pharmacies, members, providers, CalOptima Health departments, health networks and other entities in assuring the efficient, timely and effective provision of pharmaceutical products and services to CalOptima Health members. The incumbent will interact with other department staff throughout the organization, as well as external contacts daily. The incumbent is responsible for ongoing public contacts including, but are not limited to, members, individual pharmacies, member advocates, family members, health networks, Public Guardian’s Office, Regional Center and other agencies.

Duties & Responsibilities:

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.

Minimum Qualifications:

• 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.

Required Licensure / Certifications:

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

Preferred Qualifications:

• 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).

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