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Cambia Health Solutions is a nonprofit organization dedicated to changing healthcare through a “person-focused and economically sustainable system.” As an e
Pharmacy Operations Coordinator
Location
Idaho + 3 moreAll locations: Idaho | Oregon | Utah | Washington
Posted
106 days ago
Salary
$62K - $85.1K / year
Seniority
Senior
Job Description
Pharmacy Operations Coordinator
Cambia Health Solutions
• Demonstrate strong knowledge of clinical protocols, operational procedures, and systems used to support day-to-day prior authorization (PA), appeals, and related workflows, while serving as the key liaison within the PA team to ensure seamless implementation of process changes, system enhancements, and regulatory initiatives. • Support operational and regulatory requirements and initiatives by coordinating cross-departmental implementation to ensure accurate and compliant PA, appeal, and related processes across the organization. • Lead and/or contribute to preparations for compliance audits, accreditation documentation, government audits, and state audits to maintain organizational standards and regulatory compliance. • Coordinate with stakeholders to ensure new processes, procedures, regulations, and initiatives are clearly communicated, documented, and implemented in a timely and accurate manner across all affected teams. • Interact, coordinate, and communicate with all levels of management including but not limited to providers, stakeholders, and vendors to ensure effective and compliant use of systems and processes, provide project updates, and ensure coordination of activities. • Support internal audits of PA and appeal case review by reviewing authorization accuracy, validating adherence to clinical policies, and supporting continuous quality improvement initiatives. • Other duties as assigned to support the overall goals and objectives of the Pharmacy Operations Team.
Job Requirements
- Bachelor's degree required
- Minimum of 3 years of experience in the healthcare industry
- Experience must include focus in one or more of the following areas: Pharmacy operations, Prescription drug benefit administration, and/or Compliance functions
- Equivalent combination of education and experience will be considered
- Experience with health insurance, managed care, prior authorization (PA) processing, and/or prescription benefits, with a broad understanding of the processes and procedures for all areas within the Pharmacy Operations Team
- Broad understanding and knowledge of state and federal rules and regulations.
- Ability to coordinate activities with all levels of staff and external partners through clear and concise verbal and written communication skills, while organizing, planning, prioritizing, and developing multiple projects within time constraints.
- Ability to negotiate and resolve project and team issues with diplomacy and influence, with experience in applying process improvement methodology to a project or process.
- Strong analytical and conceptual skills to identify complex business problems, develop comprehensive solutions, and implement effective courses of action with strong problem-solving abilities.
- Proficiency in using MS Office products and other corporate software as required to support daily operations and project management.
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.
Benefits
- Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
- Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Award-winning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.
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