Job Detail

Job Overview
We are seeking a Certified Pharmacy Technician, Supervisor to join our team!

The Pharmacy Technician Supervisor oversees Pharmacy Benefit Management (PBM) operations, ensuring the execution of Medicare Part D initiatives, regulatory compliance, and efficient process management. This role works with vendors, consultants, healthcare providers, and members to resolve issues, manage claims, and drive improvements. The position also serves as a subject matter expert in PBM operations and regulatory oversight.

The Pharmacy Technician Supervisor description outlines the key responsibilities of the role, though it is not limited to these tasks.

KEY RESPONSIBILITIES

· Lead daily PBM operations, ensuring compliance with regulations and efficiency.

· Manage Opioid Management System (OMS) activities and report findings to the Utilization Management (UM) committee.

· Oversee Financial Information Reporting (FIR) and National Council for Prescription Drug Programs (NCPDP) transactions.

· Monitor Prescription Drug Event (PDE) rejects and perform analysis with PBM and Acumen.

· Ensure effective Peer-to-Peer (P2P) reconciliation and smooth communication in pharmacy operations.

· Collaborate with the Care Management (CM) team and preferred pharmacies on operational issues.

· Attend meetings and provide updates on pharmacy initiatives.

· Maintain and update Policies and Procedures (P&P) to meet regulatory requirements.

· Oversee compliance with state and federal claims turnaround times and payments.

· Perform pharmacy claims reviews and manage plan year benefit configuration validation.

· Support testing and validation of new plan year pharmacy benefits.

· Respond to inquiries, audits, and issues from members, stakeholders, and CMS.

· Manage work plans and prioritize resources to meet key deliverables.

· Ensure confidentiality of Protected Health Information (PHI) in compliance with regulations.

· Perform other duties as assigned to support the success of the team and department.

SUPERVISORY RESPONSIBILITIES

This does have supervisory and oversight responsibilities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Education
• High school diploma or General Educational Development (GED) required.
• Associate's or Bachelor’s degree in science preferred.
• Must have an active Certified Pharmacy Technician (CPhT) License.
• Experience
• Minimum of 3 years of experience in a pharmacy technician role, preferably with a focus on Pharmacy Benefit Management (PBM) or retail pharmacy operations.
• Proven experience in managing departmental processes or overseeing pharmacy operations.
• Knowledge, Skills, and Abilities
• Operational Acumen: Strong understanding of pharmacy operations and PBM processes.
• Decision-Making: Ability to make informed decisions quickly in a fast-paced environment.
• Time Management: Effective in prioritizing and managing tasks to meet deadlines.
• Relationship Building: Ability to build and maintain strong working relationships with team members, healthcare providers, and external partners.
• Regulatory Knowledge: Familiarity with Centers for Medicare and Medicaid Services (CMS) regulations, especially related to Medicare Part D, and proficiency with Acumen reporting tools.
• Claims Expertise: Knowledge of CMS claims payment guidelines and experience with pharmacy claims adjudication and issue resolution.
• Audit Experience: Familiarity with CMS and National Committee for Quality Assurance (NCQA) audits.
• Industry Knowledge: Understanding of Medicare Part D operations and industry best practices.

PROFESSIONAL COMPETENCIES

• Strong problem-solving skills
• Effective communicator capable of interacting across multiple levels within the organization.
• Strong analytical skills, including the ability to analyze and organize data.
• Excellent organizational, oral presentation, and written and verbal communication skills.
• Results-driven, thriving in a collaborative environment.

LICENSURES AND CERTIFICATIONS

Certified Pharmacy Technician (CPhT) License

WORK ENVIRONMENT and ESSENTIAL PHYSICAL FUNCITONS:

The majority of work responsibilities are performed in an open office setting, requiring detailed work while sitting at a desk/table and working on a computer. Some travel may be required.

Essential Physical Functions:

• Ability to work onsite in an open office setting, primarily sitting at a desk and working on a computer.
• Regularly required to talk, hear, stand, walk, sit, and use hands to handle or feel objects and controls.
• Frequently lifts/moves up to 10 pounds. Specific vision abilities include close vision and the ability to adjust focus.

EEO/AFFIRMATIVE ACTION STATEMENT

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse group of employees committed to meeting the needs of Champion Payer Solutions, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law

Job Type: Full-time

Pay: From $35.00 per hour

Expected hours: 40 per week

Benefits:

• AD&D insurance
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Work Location: Hybrid remote in Long Beach, CA 90815