Jonathan Stradling

Jonathan Stradling Email and Phone Number

Health Plan Pharmacy Operations Manager @ Samaritan Health Services
corvallis, oregon, united states
Jonathan Stradling's Location
Portland, Oregon, United States, United States
Jonathan Stradling's Contact Details

Jonathan Stradling work email

Jonathan Stradling personal email

Jonathan Stradling phone numbers

About Jonathan Stradling

My career as a pharmacy technician started in 2007 as a retail pharmacy technician at CVS/Pharmacy after graduating with a certificate from Remington College. From my humble beginnings as a lead retail pharmacy tech, I have spent the last 16 years serving Oregon Health Plan and Medicare beneficiaries.I began my Medicaid & Medicare Managed Care career in 2008 working for FamilyCare Health Plans where I essentially created the role for pharmacy technicians within the organization. In my role with FamilyCare, I wrote pharmacy drug prior authorization criteria, created reports on drug utilization for medical directors and the P&T committee, and developed training material for new technicians. Other projects included implementation of two different prior authorization platforms, a PBM transition, and the submission of plan benefit design to HPMS.In August of 2016, I accepted a position with Providence Health Plans as a Pharmacy Compliance and Product Management Coordinator. This role engaged my analytical skills as well as my skills in understanding CMS guidance to ensure MAPD operations were following Medicare guidelines. My time at Providence was cut short due to a family health crisis, but I found my experience with a larger health plan invaluable. In May of 2017 I joined CareOregon as a pharmacy benefit specialist (PBS) and was promoted to the position of Pharmacy Benefit Operations Supervisor within my first year at the organization. In my role as Pharmacy Benefit Operations Supervisor at CareOregon, I assisted in the selection of a new contact center and implemented new prior authorization platforms for drugs covered under the pharmacy benefit and drugs under the major medical benefit. I implemented schedule changes for the PBS staff that resulted in improved performance statistics for the plan's call center. With these changes, the team I supervised still maintained performance in reviewing prior authorizations, medical authorization and appeals within OHA and CMS turn around times. On March 13, 2023 I started my newest role as pharmacy operations manager with the health plan division of Samaritan Health Services.While working for CareOregon and Samaritan, I also attended online college and completed my Bachelor of Science degree in April 24, 2023 majoring in Healthcare Administration with a concentration in management.

Jonathan Stradling's Current Company Details
Samaritan Health Services

Samaritan Health Services

View
Health Plan Pharmacy Operations Manager
corvallis, oregon, united states
Website:
samhealth.org
Employees:
1904
Jonathan Stradling Work Experience Details
  • Samaritan Health Services
    Health Plans Pharmacy Operations Manager
    Samaritan Health Services Mar 2023 - Present
    Corvallis, Oregon, United States
    Manages non-clinical pharmacy benefits administration and formulary management. Areas of oversight include formulary integrity, pharmacy benefit customer service, member engagement and grievances, and vendor oversight on delegated functions in these areas. Develops and implements program standards, benchmarking, and ensures adequate quality assurance and ongoing review of processes and standards. Works closely with pharmacy management and other staff and managers across the organization in… Show more Manages non-clinical pharmacy benefits administration and formulary management. Areas of oversight include formulary integrity, pharmacy benefit customer service, member engagement and grievances, and vendor oversight on delegated functions in these areas. Develops and implements program standards, benchmarking, and ensures adequate quality assurance and ongoing review of processes and standards. Works closely with pharmacy management and other staff and managers across the organization in support of both departmental and organizational goals. Show less
  • Careoregon
    Pharmacy Benefit Operations Supervisor
    Careoregon Mar 2018 - Mar 2023
    Portland, Oregon Area
    This position is accountable for supervising pharmacy benefit operations including pharmacy customer service, medication prior-authorization and appeal processing, pharmacy program communications, and ensuring regulatory compliance. This position is also accountable for the performance of the Pharmacy Benefit Specialist and Data Entry staff. Oversight of staff includes working with staff leads to ensure performing at required competency and production levels and to implement and evaluate new… Show more This position is accountable for supervising pharmacy benefit operations including pharmacy customer service, medication prior-authorization and appeal processing, pharmacy program communications, and ensuring regulatory compliance. This position is also accountable for the performance of the Pharmacy Benefit Specialist and Data Entry staff. Oversight of staff includes working with staff leads to ensure performing at required competency and production levels and to implement and evaluate new processes and procedures that support Pharmacy programmatic goals and objectives. The Pharmacy Benefit Operations Supervisor will provide limited coverage for Pharmacy Benefit Specialist staff assignments in order to stay current with work processes, identify opportunities for process improvement and to cover work assignments during times of increased coverage needs and absences. Show less
  • Careoregon
    Pharmacy Benefit Specialist Lead
    Careoregon Feb 2018 - Mar 2018
    Portland, Oregon Area
    The Pharmacy Benefit Specialist Lead assists CareOregon members and their providers, as well as PBS team members, by providing expert level operational, clerical and project support for CareOregon’s pharmacy benefits. This position is the organization’s primary point of contact for escalated or complex issues for members, members’ representatives, providers, and pharmacies for the pharmacy benefit and claims payment process that cannot be resolved by a PBS team member. Core responsibilities… Show more The Pharmacy Benefit Specialist Lead assists CareOregon members and their providers, as well as PBS team members, by providing expert level operational, clerical and project support for CareOregon’s pharmacy benefits. This position is the organization’s primary point of contact for escalated or complex issues for members, members’ representatives, providers, and pharmacies for the pharmacy benefit and claims payment process that cannot be resolved by a PBS team member. Core responsibilities include customer service, claims processing, data entry, clerical support, prior authorizations, appeals and grievances, and project support. This position is also accountable for training, coaching, and monitoring staff, assisting with department operations and standards, and creating and maintaining procedure and processing documents. Show less
  • Careoregon
    Pharmacy Benefit Specialist Ii
    Careoregon May 2017 - Feb 2018
    Portland, Oregon
    Customer Service & Claims Processing-Communicate in a professional and respectful manner.-Maintain confidentiality within HIPAA regulations and function on “need to know” principles.-Respond to pharmacy benefit inquires in an accurate and timely manner to members, members’ representatives, providers, and CareOregon staff.-Document all customer service activities according to organization requirements.-Follow policies and procedures to answer questions from members, providers… Show more Customer Service & Claims Processing-Communicate in a professional and respectful manner.-Maintain confidentiality within HIPAA regulations and function on “need to know” principles.-Respond to pharmacy benefit inquires in an accurate and timely manner to members, members’ representatives, providers, and CareOregon staff.-Document all customer service activities according to organization requirements.-Follow policies and procedures to answer questions from members, providers and CareOregon staff regarding claims processing as it pertains to the CareOregon pharmacy benefits.-Follow policies and procedures to determine a resolution to pharmacy claims processing requests or triage to other CareOregon staff for assistance.Data Entry and Clerical Support-Sort incoming faxes and distribute according to assignments.-Maintain files according to unit protocols.-Assist with data entry into the claims processing system, document managements systems, databases and spreadsheets as assigned.-Clerical Assistance for pharmacy projects including but not limited to:- Distribution of education materials to members, providers or pharmacies- Letters & mailings- ReportsPrior Authorizations (PA) & Formulary Exceptions-Verify member’s plan eligibility and applicable pharmacy benefit.-Educate members, providers and pharmacies and CareOregon staff about the CareOregon formularies and pharmacy benefit policies.Project Participation-Under the supervision of a pharmacist and/or the operations supervisor, assist with pharmacy benefit projects including, but not limited to Accelerated Process Improvement Teams or PDSA cycles. Show less
  • Providence Health & Services
    Pharmacy Compliance And Product Management Coordinator
    Providence Health & Services Aug 2016 - Feb 2017
    Beaverton, Oregon
    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 Providence Health Plan’s (PHP) Regulatory Affairs Department. Responsible for collaboration and coordination with PHP Product Management Teams for the Medicare Part D product. Maintaining compliance in all matters of pharmacy benefit administration, responsible for serving with PHP sales and marketing… Show more 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 Providence Health Plan’s (PHP) Regulatory Affairs Department. Responsible for collaboration and coordination with PHP Product Management Teams for the Medicare Part D product. Maintaining compliance in all matters of pharmacy benefit administration, 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 Medicare beneficiaries. Lead implementation coordinator for all new custom pharmacy benefits and pharmacy projects and programs designed to enhance the overall effectiveness of pharmacy benefit administration. Served as an internal consultant to Pharmacy Director, Sales Directors, and other managers regarding all aspects of the pharmacy program. Show less
  • Familycare Health Plans
    Lead Pharmacy Technician
    Familycare Health Plans Dec 2014 - Jul 2016
    Portland, Oregon Area
    Assisted with the day-to-day supervision and scheduling Pharmacy Technician staff. Developed and provided training materials and tools to ensure successful performance of individuals and the team. Assigned, distributed, and balanced workload to and among team members. Coordinated coverage and provided support during times of unplanned absences and increased workload.Assisted the Pharmacy manager with workload, productivity, and quality monitoring and took steps to ensure established… Show more Assisted with the day-to-day supervision and scheduling Pharmacy Technician staff. Developed and provided training materials and tools to ensure successful performance of individuals and the team. Assigned, distributed, and balanced workload to and among team members. Coordinated coverage and provided support during times of unplanned absences and increased workload.Assisted the Pharmacy manager with workload, productivity, and quality monitoring and took steps to ensure established targets are met. Assisted Pharmacy manager with process and workflow improvement activities.Assisted with Medicare and Medicaid compliance monitoring and reporting activities, including data validation and CMS audits. Ran statistical data and created reports for pharmacy department performance monitoring (i.e. call volume, prior authorization volume, prior authorization turnaround times, etc.).Managed special projects and initiatives as requested by Pharmacy Manager, such as providing data and analysis on high opioid utilizers & prescribers and ADHD medication utilization in adult and pediatric populations. Show less
  • Familycare Health Plans
    Certified Pharmacy Technician
    Familycare Health Plans Apr 2008 - Dec 2014
    Portland, Oregon Area
    Reviewed prior authorization requests from providers. Assisted in formulary maintenance, including formulary benefit coding within RxClaim adjudication platform. Provided support for pharmacies and customer service to clarify prescription benefit coverage. Provided detailed training to customer service team on pharmacy benefits and software.Performed job duties in accordance with Oregon Health Authority and Medicare regulations. Created internal audit tools and reporting documents… Show more Reviewed prior authorization requests from providers. Assisted in formulary maintenance, including formulary benefit coding within RxClaim adjudication platform. Provided support for pharmacies and customer service to clarify prescription benefit coverage. Provided detailed training to customer service team on pharmacy benefits and software.Performed job duties in accordance with Oregon Health Authority and Medicare regulations. Created internal audit tools and reporting documents. Created desk references and procedures on prior authorization program and other pharmacy tasks and reports.Created letter templates for members and providers. Provided reporting and support for Medical Directors and Pharmacists. Provided data analysis and reporting to the Pharmacy & Therapeutics Committee (P&T), as well as presenting findings and providing recommendations to the committee members. Also supported P&T Committee by taking meeting minutes, organizing and scheduling quarterly meetings and following up with individual member concerns. Show less
  • Cvs/Pharmacy
    Certified Pharmacy Technician
    Cvs/Pharmacy Aug 2007 - Apr 2008
    Houston, Texas Area
    Entered prescriptions into pharmacy software, called third party payers and solved adjudication issues. Counted and filled prescriptions drugs and labeled them in preparation for dispensing.Managed pharmacy inventory including ordering and stocking daily drug deliveries.Provided general customer service, including locating over the counter (OTC) medication for customers, operating cash register and answering inbound pharmacy phone calls.

Jonathan Stradling Skills

Healthcare Managed Care Pharmacy Medicare Hipaa Healthcare Information Technology Medicaid Compounding Pharmacy Benefit Management Customer Service Utilization Management Insurance Pharmacueticals Pharmacy Technicians Prescription Pharmacy Practice Health Policy Healthcare Industry Provider Relations Medicaid Managed Care Pharmaceutical Industry U.s. Health Insurance Portability And Accountability Act Rxclaim Formulary Coding Project Management Microsoft Excel Data Analysis Microsoft Office Microsoft Outlook Excel Vizio Microsoft Visio

Jonathan Stradling Education Details

Frequently Asked Questions about Jonathan Stradling

What company does Jonathan Stradling work for?

Jonathan Stradling works for Samaritan Health Services

What is Jonathan Stradling's role at the current company?

Jonathan Stradling's current role is Health Plan Pharmacy Operations Manager.

What is Jonathan Stradling's email address?

Jonathan Stradling's email address is st****@****gon.org

What is Jonathan Stradling's direct phone number?

Jonathan Stradling's direct phone number is +150322*****

What schools did Jonathan Stradling attend?

Jonathan Stradling attended University Of Phoenix, Remington College, University Of Phoenix.

What are some of Jonathan Stradling's interests?

Jonathan Stradling has interest in Writing, Children, Politics, Civil Rights And Social Action, Environment, Health Care, Science And Technology, Music, Philosophy, Human Rights.

What skills is Jonathan Stradling known for?

Jonathan Stradling has skills like Healthcare, Managed Care, Pharmacy, Medicare, Hipaa, Healthcare Information Technology, Medicaid, Compounding, Pharmacy Benefit Management, Customer Service, Utilization Management, Insurance.

Who are Jonathan Stradling's colleagues?

Jonathan Stradling's colleagues are Aleigh R., Janis Wilkinson, Roy Starbeck, Bonita Hobbs, Mythili Ransdell, Terri Dobbs, David Federoff.

Not the Jonathan Stradling you were looking for?

Free Chrome Extension

Find emails, phones & company data instantly

Find verified emails from LinkedIn profiles
Get direct phone numbers & mobile contacts
Access company data & employee information
Works directly on LinkedIn - no copy/paste needed
Get Chrome Extension - Free

Aero Online

Your AI prospecting assistant

Download 750 million emails and 100 million phone numbers

Access emails and phone numbers of over 750 million business users. Instantly download verified profiles using 20+ filters, including location, job title, company, function, and industry.