Customer support specialist jobs in Redlands, CA - 1,809 jobs

Pharmacy Services Specialist (Clinical Programs ‐ Stars) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Pharmacy Services Specialist (Clinical Programs ‐ Stars) and help shape the future of healthcare where you'll be an integral part of our Pharmacy Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework. If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. You will utilize specialized pharmacy knowledge and expertise to assist participating pharmacies, members, providers, CalOptima Health departments, health networks and other entities in assuring the efficient, timely and effective provision of pharmaceutical products and services to CalOptima Health members. You will interact with other department staff throughout the organization, as well as external contacts daily. You will be responsible for ongoing public contacts including, but are not limited to, members, individual pharmacies, member advocates, family members, health networks, Public Guardian's Office, Regional Center and other agencies. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 85% ‐ Program Support Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability. Conducts outbound calls to members, pharmacies, and providers in an effort to improve Star measure performance for medication adherence and other Star programs as needed. Using a pharmacy computer program, retrieves drug‐specific technical data and information necessary for the completion of departmental and interdepartmental pharmacy‐related functions and operations. Assists with resolution of provider and member pharmacy issues requiring specialized technical and professional knowledge and expertise, including pharmacy authorizations. Supports the department with claims disputes between providing pharmacies, the pharmacy claims administrator, CalOptima Health Claims Department and other entities as necessary. Interprets and articulates Pharmacy Management program policies and procedures to pharmacy providers, other providers, other CalOptima Health staff, external agencies and others as required. Assists in the processing of pharmaceutical prior authorization and appeals requests as per the CalOptima Health Prior Authorization Guidelines as needed. Establishes and maintains key contacts both internally and externally to assure appropriate coordination and provision of pharmacy services to CalOptima Health Members. Accepts referrals from Member Services and work in conjunction with employees from this department to resolve all pharmacy‐related member complaints, including those related to the pharmacy authorization process. Assists pharmacies and health plans in resolving member‐specific pharmacy services access issues, removing barriers to access to pharmaceutical services. Identifies pharmacy‐related resources and recommend new procedures, processes or activities that help assure the efficient provision of pharmacy services to members. 10% ‐ Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department. Maintains documentation of the Stars adherence program and other Stars program outreach according to the internal guidelines. 5% ‐ Completes other projects and duties as assigned. Do You Have What the Role Requires? High School diploma or equivalent PLUS 1 year of experience as a pharmacy technician required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. You'll Stand Out More If You Possess the Following: Associate degree in a health‐related field. Pharmacy Technician Certification Board (PTCB). Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese). What the Regulatory Agencies Need You to Possess? A current, valid, unrestricted California Pharmacy Technician license required. Your Knowledge & Abilities to Bring to this Role: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem‐solve and possess project management skills. Work in a fast‐paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi‐program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Your Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Ways We Are Here For You You'll enjoy competitive compensation for this role. Our current hiring range is: Pay Grade: 301 ‐ $47,840 ‐ $64,584 ($23.00 ‐ $31.0500).