Job Information
CareOregon Pharmacy Benefit Coordinator II in Portland, Oregon
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”
Physical Skills and Abilities Required
Lifting/Carrying up to 10 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
More than 6 hours/day
More than 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:
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.
