Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, or Nevada.
Position Title: Pharmacy Benefit Specialist Lead
Department: Pharmacy
Title of Manager: Pharmacy Benefit Operations Supervisor
Supervises: Non-supervisory position
Exemption Status: Non-Exempt
Requisition ID: 23552
Pay and Benefits: Estimated hiring range $45,850 – $55,500, 10% lead pay, 5% bonus target, full benefits. To learn more about our benefits, please visit www.careoregon.org/about-us/careers/benefits
Job Summary
This position is responsible for working with CareOregon members, their providers, and pharmacies to support the pharmacy benefit and prescription needs under the major medical benefit. This is an advanced level support position, requiring Pharmacy Technician Certification, as well as leadership to pharmacy team members. Core responsibilities include training, coaching, and monitoring staff work and assisting leadership with department processes, as well as customer service, claims processing, prior authorizations, formulary exceptions, appeals, grievances, and project leadership or participation.
Essential Responsibilities
Leadership
Customer Service and Claims Processing
Data Entry and Clerical Support
Prior Authorizations (PA) and Formulary Exceptions
Appeals and Grievances
Project Coordination
Under the supervision of a pharmacist and/or the operations supervisor, perform and/or lead pharmacy benefit projects, including, but not limited to accelerated process improvement teams or PDSA cycles, cost saving initiative projects, benefit implementation/changes, member/provider/pharmacy outreach, assist in training new hire staff, and create and upkeep standard operating procedures.
Organizational Responsibilities
Knowledge, Skills and Abilities Required
Expert knowledge in some or all of the following areas:
Technical
Communication
Cognitive and Others
Physical Skills and Abilities
Lifting/Carrying up to 0 Pounds Pushing/Pulling up to 0 Pounds Pinching/Retrieving Small Objects Crouching/Crawling Reaching Climbing Stairs Repetitive Finger/Wrist/Elbow/ Shoulder/Neck Movement | 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day | Standing Walking Sitting Bending Seeing Reading Hearing Speaking Clearly | 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day More than 6 hours/day 3-6 hours/day 3-6 hours/day |
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:
Preferred:
Working Conditions
Inside/office Clinics/health facilities Member homes
Other_________________________________________
#Li-Remote
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.
Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
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We are an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, national origin, disability, veteran status, and other protected characteristics. The EEO is the Law poster is available here.
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