Jonathan Stradling Email and Phone Number
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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.
Samaritan Health Services
View- Website:
- samhealth.org
- Employees:
- 1904
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Health Plans Pharmacy Operations ManagerSamaritan Health Services Mar 2023 - PresentCorvallis, Oregon, United StatesManages 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 -
Pharmacy Benefit Operations SupervisorCareoregon Mar 2018 - Mar 2023Portland, Oregon AreaThis 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 -
Pharmacy Benefit Specialist LeadCareoregon Feb 2018 - Mar 2018Portland, Oregon AreaThe 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 -
Pharmacy Benefit Specialist IiCareoregon May 2017 - Feb 2018Portland, OregonCustomer 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 -
Pharmacy Compliance And Product Management CoordinatorProvidence Health & Services Aug 2016 - Feb 2017Beaverton, OregonDesignated 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 -
Lead Pharmacy TechnicianFamilycare Health Plans Dec 2014 - Jul 2016Portland, Oregon AreaAssisted 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 -
Certified Pharmacy TechnicianFamilycare Health Plans Apr 2008 - Dec 2014Portland, Oregon AreaReviewed 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 -
Certified Pharmacy TechnicianCvs/Pharmacy Aug 2007 - Apr 2008Houston, Texas AreaEntered 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
Jonathan Stradling Education Details
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Health/Health Care Administration/Management -
Remington CollegePharmacy Technician -
Health/Health Care Administration/Management
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.
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Jonathan Stradling, MBA, CPSM
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