Pharmacy Benefit Coordinator II

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

Position Title: Pharmacy Benefit Coordinator II

Exemption Status: Exempt

Department: Pharmacy

Title of Manager: Pharmacy Medicare Manager

Supervises: N/A

Requisition: 24583

Pay & Benefits: Pay & Benefits: Estimated hiring range $71,340 - $87,200 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits

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 leading 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 II responds to and resolve external customer and internal staff/departments needs regarding pharmacy benefits.

Essential Position Functions

• Manage medium to large 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.
• Perform 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.
• Perform pharmacy data analysis to develop, test, monitor and confirm a successful implementation and monitoring plan for pharmacy department assignments.
• Represent the pharmacy department and/or facilitate key implementation, client support and operational meetings regarding the status and function of the pharmacy benefit.
• Act as a subject matter expert 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.
• Maintain progress in seeing 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

• Advanced knowledge of and demonstrated ability to work with Medicaid, Medicare and Special Needs members preferred
• Advanced research skills, 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
• Strong ability to use good judgment, personal initiative and discretion to perform job responsibilities
• Strong ability to monitor and recognize questions, tasks or workflows for work that requires a pharmacist professional judgment and ensure pharmacists are asked for assistance
• Advanced knowledge of medical, pharmaceutical and managed care terminology
• Excellent interpersonal and customer service skills
• Strong written and verbal communication and documentation skills
• Advance reporting and analytical skills
• Strong project management and training skills
• 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
• Demonstrate progress in seeing the big picture beyond a request and taking appropriate holistic action, employing "systems thinking"

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 4 years' in pharmacy benefits experience, including two (2) years as a pharmacy benefit coordinator
• Advanced experience with Excel spreadsheet and data file manipulation for the purpose of testing and validating pharmacy benefit set-ups and maintenance and producing regulatory reports

Preferred:

• Project management certification or project management course work
• Strong knowledge of CMS guidelines and Medicare Part D are highly preferred.

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.