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Pharmacy Management
| 2025-07-31 17:34:26
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Duties & Responsibilities:

  • 95% - Program Support
    • 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.
    • Handles specified caseloads to ensure cases are resolved within departmental standards and maintains documentation of member and pharmacy cases.
    • Retrieves drug-specific technical data and information necessary to complete departmental and interdepartmental pharmacy-related functions and operations.
    • Assists network pharmacies and prescribers with the resolution of pharmacy-related issues such as billing, claims processing, eligibility or pharmacy authorization requests.
    • Resolves claims disputes between network pharmacies, pharmacy claims administrator, CalOptima Health’s Claims department and other entities as necessary.
    • Interprets and articulates Pharmacy Management program policies and procedures to pharmacy providers, other providers, CalOptima Health staff, external agencies and others as needed.
    • Assists in processing pharmaceutical prior authorization and appeals requests per the CalOptima Health prior authorization guidelines.
    • Establishes and maintains key contacts internally and externally to assure appropriate coordination and provision of pharmacy services to CalOptima Health members.
    • Processes referrals from and works in conjunction with the Customer Service department to resolve all pharmacy-related member complaints and prior authorization requests. 
  • 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 in the ambulatory, community, home infusion, long-term care or managed care setting 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.

Preferred Qualifications:

  • Associate’s degree in a health-related field.
  • Pharmacy Technician Certification Board (PTCB) credentials.
  • Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

Required Licensure / Certifications:

  • Completion of an accredited Pharmacy Technician training program and possession of a registration certificate as a Pharmacy Technician from the California Board of Pharmacy required.

Knowledge & Abilities:

  • Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.  
  • Work independently and exercise sound judgment.
  • Communicate clearly and concisely, both orally and in writing.
  • Work a flexible schedule; available to participate in evening and weekend events.
  • Organize, be analytical, problem-solve and possess project management skills.
  • Work in a fast-paced environment and in an efficient manner.
  • Manage multiple projects and identify opportunities for internal and external collaboration.
  • Motivate and lead multi-program teams and external committees/coalitions.
  • Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

  • Ability to visually read information from computer screens, forms and other printed materials and information.
  • Ability to speak (enunciate) clearly in conversation and general communication.
  • Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
  • Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
  • Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Work Environment:

If located at the 500, 505 Building or a remote work location:

  • Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
  • There are no harmful environmental conditions present for this job.
  • The noise level in this work environment is usually moderate.

If located at PACE:

  • Work is typically indoors in a clinical setting serving the frail and elderly.
  • There may be harmful or hazardous environmental conditions present for this job.
  • The noise level in this work environment is usually moderate to loud.

If located in the Community:

  • Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. 
  • Employee will occasionally work outdoors in varied temperatures.
  • There may be harmful or hazardous environmental conditions present for this job.
  • The noise level in this work environment is usually moderate to loud.