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Career Opportunities: Pharm Benefits Coordinator I (24631) Requisition ID 24631 - Posted 10/09/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (18) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Position Title: Pharmacy Benefit Coordinator I Requsition #: 24631 Department: Pharmacy Title of Manager: Pharmacy Manager Supervises Non-Supervisory Position Exemption Status: Exempt Pay and Benefits: Pay and Benefits: Estimated hiring range $64,130 - $78,390/ year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes: 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 providing 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 I responds to external customer and internal staff/departments needs regarding pharmacy benefits. Essential Position Functions Manage small to medium 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. Assist in performing 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. Facilitate with an analyst and/or perform pharmacy data analysis directly to develop, test, monitor and confirm a successful implementation and monitoring plan for pharmacy department assignments. Represent the pharmacy department at key implementation, client support and operational meetings regarding the status and function of the pharmacy benefit. Act as a point of contact 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. Learning to see the big picture beyond a request and taking appropriate ho