Position Overview
Ultimate Staffing Services is seeking a diligent and detail-oriented Pharmacy Coordinator for a full-time position based in California. The Pharmacy Coordinator will play a crucial role in reviewing and processing prior authorizations, ensuring compliance with all applicable regulations, and supporting various pharmacy-related functions. This position requires an individual who is proactive, organized, and capable of managing multiple tasks in a dynamic environment.
Responsibilities
- Review and process prior authorization requests for medications using pharmacy clinical criteria and guidelines.
- Direct and refer complex prior authorization requests to Clinical Pharmacists.
- Maintain communication with pharmacies and physician offices, resolving technical processing issues and escalating unresolved issues.
- Utilize appropriate language for approval and denial letters.
- Assist in claims report processing and review, as well as the development and implementation of clinical programs.
- Support formulary and benefit change submissions and assist in audits conducted by DHCS, DMHC, CMS, and department programs.
- Handle inquiries related to prior authorization approvals/denials and claims processing.
- Provide support in processing claims, troubleshooting, and adjudication, as well as assisting with overrides and member eligibility inquiries.
- Participate actively in departmental meetings, training, and coaching sessions.
- Perform additional related duties as required or assigned.
Qualifications
- High School Diploma or GED is required.
- Active Pharmacy Technician License without restriction is required.
- PTCB pharmacy certification is desired.
- Minimum of two years of pharmacy experience in a managed care, hospital, long-term care, specialty compounding, infusion center, or retail pharmacy setting is required.
- Proficiency in meeting accuracy and timeline requirements to maintain regulatory compliance is required.
- Knowledge of prior authorization (PA) or treatment authorization requests (TAR) is required.
- Familiarity with generic and brand name equivalents, as well as Medi-Cal and Medicare prescription drug benefits and claims processing, is required.
- Experience processing Medi-Cal, Medicare Part D, claims, and Durable Medical Equipment (DME) authorizations is desired.
- Ability to adapt to changing situations and efficiently alternate focus between tasks as needed is required.
- Proficiency in using applicable computer software, including Outlook, Word, Excel, and PBM web-based platforms, is required.
- Excellent communication skills, with the ability to express oneself clearly and concisely in various formats, are required.
- Ability to think and work effectively under pressure, prioritizing and completing tasks within established timeframes, is required.
- Strong decision-making skills and the ability to maintain confidentiality are required.
Required Work Hours
Monday to Friday, 8:00 AM - 5:00 PM
Benefits
Competitive pay with a range of $28 - $35 per hour.
All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.