Providence Health & Services Compliance and Product Management Coordinator in Beaverton, Oregon
Providence is calling a Compliance and Product Management Coordinator to Providence Health Plan in Beaverton, OR.
In this position, you will:
Serve two primary purposes within the Pharmacy Department at Providence Health Plans (PHP). First, you will be the designated pharmacy contact with state and federal regulatory staff at the Centers for Medicare and Medicaid Services (CMS), the states of Oregon and Washington Insurance Divisions and PHP’s Regulatory Affairs Department. Second, you will be responsible for collaboration and coordination with PHP Product Management Teams for the following products: Medicare Part D, Commercial Group Drug Benefits, Individual Product Drug Benefits, H.SA Group and Individual Drug Benefits, Self-Insured (ASO) Drug Benefits, and Medicaid (OHP) Drug Benefits
Play a role in Pharmacy Program Compliance Requirements. You will coordinate the development, implementation, and evaluation of plan-wide compliance activities for all pharmacy benefit products offered by Providence Health Plans. You will serve as an internal consultant to senior leadership, management, and staff at PHP and Providence Health & Services (PHS) regarding pharmacy programs, policies, benefits, and associated administrative rules specific to the application of pharmacy prescription drug benefits for the health plans membership in Oregon, Washington, California, Alaska, Montana and such other states that health plan membership may reside. You will also consult with Pharmacy Director and PHP management regarding pharmacy practice and public policy issues affecting Pharmacy Benefit Management.
Play a role in PHP Pharmacy Product Benefit Management: recognizing PHP’s requirement to maintain compliance in all matters of pharmacy benefit administration, you will be responsible for serving with PHP sales and marketing representatives and managers, as well as operational managers, and other staff work teams and committees charged with the evaluation, design, development, implementation, and on-going assessment of pharmacy products offered to employer groups and individuals for every type of product offered by PHP.
Lead implementation coordinator for all new custom pharmacy benefits and pharmacy projects and programs designed to enhance the overall effectiveness of pharmacy benefit administration. You will serve as an internal consultant to Pharmacy Director, Sales Directors, and other managers regarding all aspects of the pharmacy program as they relate to provision of pharmacy services to employers and their employees. In addition, you will serve as an external consultant to employer groups regarding pharmacy benefit design and opportunities to manage prescription drug costs.
Be expected to maintain a working knowledge of PHS, including PHP goals and objectives as well as strategic initiatives pertaining to provision of pharmacy services within health plans. The successful employee in this position is expected to perform all duties in a manner that promotes inter and intra-departmental coordination while reflecting the PHS mission, philosophy, and core values of respect, compassion, justice, excellence, and stewardship.
Be required to be available on call per the departments defined schedule and to have systems and processes in place for contingency needs in the event of natural or other health care related disasters when need for medications will be escalated since this position supports a 24 hour 7 day per week “point-of-service pharmacy prescription claim system”.
Providence Health Plans is a managed care, preferred provider, ASO and workers’ compensation organization covering 750,000 lives. Pharmacy services are provided through an internal pharmacy benefit management department that is responsible for the provision of health plan pharmacy benefits for multiple lines of business including commercial, ASO, Medicaid, Medicare, Individual, and H.SA health plan clients. The provision of these health plan benefits is facilitated through the use of two key technology vendor contracts responsible for prescription claims processing of 10,000- prescriptions per month and the billing of pharmaceutical rebates to pharmaceutical companies. This position is structured to clearly define pharmacy benefit programs so that systems may be implemented to meet business needs, while recognizing the interdependency that our outsourced systems have with Facets, CMS, regulatory requirements and our provision of sales and customer service, in conjunction with participating pharmacies claims processing and contract administration.
Required qualifications for this position include:
Bachelors’ degree in business, healthcare administration, or healthcare related field -or- associates degree with additional 4 years of experience
Medication and drug product category training and medical terminology
National certification as pharmacy technician within 1 year of employment -and- licensure in Oregon as a pharmacy technician
5 years of experience in healthcare service field as a business analyst, project manager, compliance coordinator or pharmacy technician responsible for pharmacy benefit administration
Demonstrated successful and progressive staff or management experienced
Strong computer skills required including NCPDP standards knowledge, data entry and file transfer knowledge
Proficient knowledge and ability to utilize all Microsoft Office software – including Excel, Word, PowerPoint, and Access
Ability to utilize Argus Health Systems tools, CMS required electronic tools for uploading, and Facets or other major claims processing system
Preferred qualifications for this position include:
Experience and extensive knowledge in regulatory matters pertaining to Medicare Part D and pharmacy operations
Managed care pharmacy experience
Project management, Six Sigma, Change Acceleration Process (CAP), LEAN, and Work Out training and experience
Preference will be given to candidates that have been employed within the pharmacy services team of a health plan or pharmacy benefit manager.
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Pharmacy Technician
Req ID: 192406