Pharmacy Operations Coordinator

Pharmacy Operations Coordinator

Work from home Within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our
Cause
to create a person-focused and economically sustainable health care system.

Every day, Cambia's dedicated Pharmacy Operations Coordinator, are living our mission to make healthcare easier and lives better. As a member of Pharmacy Operations Team, our Pharmacy Operations Coordinator is responsible for coordinating operational and cross-functional teams to deliver initiatives that optimize prior authorization (PA) operations through enhanced efficiency, regulatory compliance, training, and quality improvements, all in service of creating a person-focused health care experience.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

• 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, with leadership skills and the ability to direct activities of others both individually and within a project team setting
• 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

• 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

#LI – Remote

The expected hiring range for a Pharmacy Operations Coordinator is $62,000 – $85,100 salary depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $59,000 - $97,000

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a…