<p>We are so glad you are interested in joining Sutter Health!</p> <p>Organization:</p> <p>SHSO-Sutter Health System Office-Valley</p> <p>Position Overview:</p> <p>This role oversees and administers pharmacy benefits for Sutter Health's value based pharmacy health plan services, including Sutter Health Plan HMO, serving as a pharmacy benefit and drug coverage subject matter expert responsible for reviewing pharmacy-related appeals and grievances by conducting clinical reviews under the supervision of a pharmacist, developing compliant administrative determinations, resolving escalated member issues, and educating members and internal stakeholders on appropriate use of benefits and resources. This position also supports workflow and desk-level-procedure development, maintenance, and optimization.</p> <p>Job Description:</p> <p>Please Note: While this position is listed as hybrid, regular in-office attendance is required. Candidates should be prepared to commute to the office on a consistent basis to support team collaboration and business needs.</p> <p>EDUCATION:</p> <ul> <li>Other: Graduate of an accredited pharmacy technician program. </li></ul> <p>CERTIFICATION & LICENSURE:</p> <ul> <li>PHARMC-Certified Pharmacy Technician </li></ul> <p>TYPICAL EXPERIENCE:</p> <ul> <li>2 years recent relevant experience </li></ul> <p>PREFERRED EXPERIENCE:</p> <ul> <li> <p>Prior Authorizations</p> </li><li> <p>Appeals & Grievances</p> </li><li> <p>Coverage Determinations</p> </li><li> <p>Integrated Delivery Systems</p> </li><li> <p>Managed Care PBM</p> </li></ul> <p>SKILLS AND KNOWLEDGE:</p> <ul> <li> <p>Knowledge of data fields required by National Council for Prescription Drug Programs (NCPDP).</p> </li><li> <p>Ability at running ad hoc reports from pharmacy claims data with strong PC skills including PowerPoint, Access, Outlook, Excel and Word.</p> </li><li> <p>Knowledge of Health Insurance Portability and Accountability Act (HIPAA), Health Care Reform, Business Code of Ethics and government regulated programs.</p> </li><li> <p>Ability to work collaboratively, prioritize functions, problem solve, and anticipate upcoming issues for the executives.</p> </li></ul> <p>These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).</p> <p>Job Shift:</p> <p>Days</p> <p>Schedule:</p> <p>Full Time</p> <p>Shift Hours:</p> <p>8</p> <p>Days of the Week:</p> <p>Monday - Friday</p> <p>Weekend Requirements:</p> <p>None</p> <p>Benefits:</p> <p>Yes</p> <p>Unions:</p> <p>No</p> <p>Position Status:</p> <p>Non-Exempt</p> <p>Weekly Hours:</p> <p>40</p> <p>Employee Status:</p> <p>Regular</p> <p>Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.</p> <p>Pay Range is $44.76 to $55.94 / hour</p> <p>The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.</p>