Project Specialist (Pharmacy Management) (13058-101218)

Caloptima Orange , CA 92856

Posted 2 months ago

Under general supervision, provides Pharmacy Management specialized tasks relevant to assigned projects. This position is responsible for assisting with department operational monitoring reports and coordination with Compliance and Audit & Oversight regarding departmental and Pharmacy Benefit Manager (PBM) oversight for all CalOptima lines of business. Provides feedback to pharmacy management to help prioritize improvement opportunities and monitor performance.

Position Responsibilities:

  • Plans and facilitates continuous improvement activities and practices with a focus on the elimination of waste and rework, improving quality, reducing operational costs, improving efficiencies and standardizing processes/procedures.

  • Works collaboratively with department managers to identify process improvement opportunities.

  • Participates in and represents the department in client calls with the Pharmacy Benefit Manager (PBM) as needed.

  • Develop, implement and monitor policies and procedures.

  • Develop and distribute reports and perform analyses.

  • Performs routine and ad hoc reporting, including designing reports and desktop procedures for department activities.

  • Develop project plans for implementing improvements and monitor new process to ensure they achieve desired results.

  • Monitors and communicates deficiencies identified from complaints, grievances and trend reports; recommends solutions for improvement.

  • Assists with developing tools for training by collaborating with team members and other departments.

  • Identifies best practices to ensure compliance with regulatory guidelines.

  • Runs reports by utilizing Q/A databases.

  • Other projects and duties as assigned.

Required Skills

  • Conduct research and make recommendations on findings with minimal assistance.

  • Design and run reports from Access and Excel databases.

  • Prioritize workload based on business needs.

  • Multi-task and work independently.

  • Be well organized and detail-oriented.

  • Communicate effectively, both verbally and in writing.

Required Experience

Experience & Education:

  • Bachelor's degree in Health Policy, Health Care, or related field highly desired.

  • Completion of an accredited Pharmacy Technician training program, possessing a registration certificate as a Pharmacy Technician from the California Board of Pharmacy preferred.

  • 3+ years of experience as a Pharmacy Technician.

  • Familiarity with Medi-Cal and Medicare requirements.

  • Excellent time management skills, organization, and the ability to be detail-oriented are required.

  • Strong understanding of pharmacy benefit design, managed care pharmacy operations, formularies and pharmacy nomenclature.

  • Medi-Cal managed care and Medicare Part D Plan operations experience highly preferred.

Knowledge of:

  • DHCS and CMS regulations.

  • Claims managed care benefits and adjudication including both Medi-Cal and Medicare.

  • Services, policies, and general responsibilities and requirements/regulations of programs.

  • Practices and techniques required to function with other professionals working in an assigned program.

  • Methods and techniques for organizing and implementing programs and projects.

  • Health Insurance Portability and Accountability Act (HIPAA).

  • Strong knowledge of Access, Excel, Word, Outlook Access and PowerPoint.

Grade: K


Job Location Orange, California, United StatesPosition TypeFull-Time/Regular


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Project Specialist (Pharmacy Management) (13058-101218)