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Pharmacy Operations Specialist III, Benefits

Primary Location Sterling, Virginia Schedule Full-time Shift Day Salary $196000 - $226600 / year

Job Number 1403330 Date Posted 01/15/2026

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Job Summary:

In addition to the responsibilities listed below, this position is responsible for using a working knowledge of pharmacy benefits to work with pharmacy and health care professionals to improve member service, affordability, and access; assisting the implementation of benefits across necessary business lines (e.g., Commercial, Medicare, Self-funded, Exchanges, Medicaid) and determining benefit compliance with federal regulations and legislation; solving standard related to administrative activities including management of vendors, claim adjudication, audits, network management, drug pricing, and sales support including request for proposals; assisting the facilitation of benefit training for health plan staff and external audiences with a focus on federal and regulatory compliance; suggesting improvements for the design, development, modification and implementation of new and current pharmacy benefits.

Essential Responsibilities:

Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
Independently provides support to pharmacy and healthcare professionals by: leveraging systems related to analytics and informatics to support relevant patient-facing teams; collaborating with meetings and relevant committees to support front-line operations; and exercising a patient focus throughout ones technical expertise and activities and identifying patient related issues, challenges, possible improvements and taking action to ensure the downstream patient impacts are being followed up on.
Supports various functions within operations and may support operations in a specific area by: collaborating with interdisciplinary teams to implement pharmacotherapy safety practices and initiatives; implementing pharmacy operations initiatives and programs that directly support the day to day functioning of a specified set of pharmacies or locations and coordinates with relevant groups on the rollout, staffing, education, etc. requirements; and supporting operational needs (e.g., workflow management, policy management, systems improvement, etc.) and ensuring policy compliance.
Contributes to service, affordability, people, quality of care, and regulatory pharmacy goals by: coordinating efforts to create, design, and help implement strategic plan to support improvements to service, quality, people, affordability, and regulatory initiatives; evaluating data trends from tools and dashboards to support implementation of new programs and initiatives; reviewing and influencing others to conduct sweeps of new laws and rules from regulatory agencies and ensures application into operations (e.g., FAQs to markets); contributing to the building and socializing of new tools to promote awareness and use; evaluating accuracy of inputs into accountability dashboard to ensure rules are followed; and aligns own operations goals to key affordability metrics.
Begins to serve as a subject matter expert for quality improvement processes and regulations within assigned area by: maintaining awareness of current internal policies and relevant external laws, regulations, and standards and serves as a source of expertise within certain defined areas; coordinating sub-projects on committees that provide input and guidance on various improvement initiatives; developing, conducting, coordinating, and beginning to identify quality improvements related to medication safety for assigned clinical area; researching and reporting related material; identifying issues and escalating to engagement manager/sponsor to resolve; leveraging basic knowledge of drugs and their uses and how they impact clinical practices; guiding members, patients and/or healthcare providers to understand appropriate use and application of prescribed medication and providing drug information to relevant healthcare providers; leveraging standard application of strategy to ensure achievement of member financial and therapeutic objectives; and monitoring member data to help assess plan outcomes.

Knowledge, Skills and Abilities: (Core)

Ambiguity/Uncertainty Management
Attention to Detail
Business Knowledge
Communication
Critical Thinking
Cross-Group Collaboration
Decision Making
Dependability
Diversity, Equity, and Inclusion Support
Drives Results
Facilitation Skills
Health Care Industry
Influencing Others
Integrity
Learning Agility
Organizational Savvy
Problem Solving
Short- and Long-term Learning & Recall
Teamwork
Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

Compliance Management
Service Focus
Workplace Safety Awareness

Minimum Qualifications:

Minimum two (2) years of experience in Pharmacy Benefits.
Doctorate of Pharmacy or equivalent degree (e.g., Bachelors of Pharmacy from a School of Pharmacy).

Pharmacist License (Virginia) within 12 months of hire

Pharmacist License (from any state) required at hire

Preferred Qualifications:

Two (2) years of experience working in a large matrixed organization.
One (1) year of experience in project management.

Primary Location: Virginia,Sterling,Central Pharmacy - Sterling Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 08:00 AM Working Hours End: 06:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Remote Employee Status: Regular Employee Group/Union Affiliation: NUE-MAS-01|NUE|Non Union Employee Job Level: Individual Contributor Department: Central Pharmacy - Rx Admin-Rx Benefit Management - 1808 Pay Range: $196000 - $226600 / year Kaiser Permanente is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills and geographic location along with a review of current employees in similar roles to ensure that pay equity is achieved and maintained across Kaiser Permanente. Travel: No Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

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