Jonathan Stradling Email & Phone Number

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

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

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

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

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

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

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

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.

Associate Of Arts (A.A.), Health/Health Care Administration/Management

Associate of Arts in Health Care Administration, concentrating in pharmacy practice

Certificate, Pharmacy Technician

Activities and Societies: President's List

Bachelor Of Science - Bs, Health/Health Care Administration/Management

Activities and Societies: Dean's List Bachelor of Science in Healthcare Administration focusing on healthcare management.