Job Details

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CalOptima
  • Position Number: 4022996
  • Location: Orange, CA
  • Position Type: Health - Healthcare Administration


Pharmacy Services Specialist (Clinical Programs)

Job Description
Department(s): Pharmacy Management
Reports to: Supervisor Pharmacist
FLSA status: Non-Exempt
Salary Grade: C - $43,281 - $58,300



About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About the Position

The Pharmacy Services Specialist utilizes 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 interacts with other 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.



Position Responsibilities:
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Coordinates outbound calls to Medication Therapy Management (MTM) eligible members in accordance with MTM program desktops.
  • Maintains documentation of MTM program activities in various systems such as Guiding Care, MTM Vendor software and Facets.
  • Documents member and pharmacy cases in Facets and manage case load to ensure cases are resolved within departmental standards as needed.
  • Functions efficiently and productively in the pharmacy call center as needed and adhere to department policies and procedures.
  • Using a pharmacy computer program, retrieve 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 Claims Department and other entities as necessary.
  • Interprets and articulates Pharmacy Management program policies and procedures to pharmacy providers, other providers, other CalOptima staff, external agencies and others as required.
  • Assists in the processing of pharmaceutical prior authorization and appeals requests as per the CalOptima 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.
  • Completes other projects and duties as assigned.



Experience & Education:
  • High School diploma or equivalent required.
  • A current, valid, unrestricted California Pharmacy Technician license required.
  • 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 is also qualifying.


Preferred Qualifications:
  • Associates degree in health-related field preferred.
  • Pharmacy Technician Certification Board (PTCB) preferred.
  • Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) preferred.


Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Physical demands: While performing duties of job, employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Employee must be able to communicate, particularly for regular phone use.
  • Work Environment: Typical office environment with minimal noise levels and controlled office temperatures.


About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.


Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4205








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