CareMore Pharmacy Compliance Spec
WellPoint 674 reviews - Cerritos, CA

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CareMore is looking for dynamic individuals to join our team!

CareMore is a leading healthcare system specializing in providing a complete, pro-active health care experience to Senior Americans. CareMore strongly believes in our innovative and caring vision to lead the next generation of health care and we look for candidates that share in our passion.

As a leader in senior healthcare for over 20 years, our vision is to significantly improve the lives of Medicare recipients throughout California by employing a dedicated staff of professionals who are passionate about changing lives. When you join CareMore, we’ll give you every opportunity to make a real difference.

Be More with CareMore.

Responsible for ensuring effective and efficient Pharmacy Compliance Programs. Primary duties may include, but are not limited to: Oversees compliance and regulatory issues including policies and procedures, audit preparation, data sampling, and Part D issues. Reviews Part D submissions for accuracy and compliance. Assists with the development of internal reporting to meet Centers for Medicaid and Medicare Services (CMS) regulations. Maintains consistent application of standard and choice of compliance action across all contracts. Maintains and ensures compliance of company and departmental policies and procedures. Creates, maintains, and updates departmental training materials. Maintains a schedule and calendar of quality assurance activities for the prior authorization process including ensuring statistically valid sampling of prior authorization cases. Assists in the implementation of goals, objective, plans, and policies to achieve selected clinical outcomes.

Job Qualifications

Certified Pharmacy Technician (CPhT) highly preferred or equivalent of 5 years related experience.

Pharmacy Claims Processing Computer System experience (preferred)

Advanced working knowledge PBM group set-up and unique group controls and plan design features.

Knowledge of pharmaceutical products, drug names, dosage forms, and pharmacy terminology.

General knowledge of pharmacology for major drug categories.

Managed care experience and/or knowledge required.

Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).

  • Current WellPoint associates: All referrals must be submitted through the formal
associate referral process on WorkNet. Official guidelines for the associate referral
program can be found in My HR.

  • WARNING: Please beware of phishing scams. Our company will never ask
you for bank account information when you are applying for a job.

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674 reviews
It’s a powerful combination. It’s the foundation upon which we’re creating greater care for our members, greater value for...