- WTW (Pittsburgh, PA)
- …benefit plan analysis, design and cost savings strategies + Pharmacy Benefits Manager ( PBM ) vendor procurement and negotiation + Audits of PBM performance ... (financial and operational) + Strategy for Specialty pharmacy products + Support the generation of new business by participating in prospecting opportunities with new clients as part of a broader team + Build relationships internally and collaborate… more
- Prime Therapeutics (Harrisburg, PA)
- …advice to internal clients including senior and executive leadership in PBM , pharmacy, specialty pharmacy, government programs, administrative support functions or ... limited to: leading them through legal analysis, collaboration processes, education on PBM activities, support for Prime's various positions on legal matters, etc. +… more
- Prime Therapeutics (Harrisburg, PA)
- …with regulatory compliance requirements (HIPAA and/or PCI) + Previous experience in PBM / health care industry + Previous experience working in an Agile/Product ... Delivery model + Strong experience with software development life cycle and project management principles + In-depth knowledge of two or more architectural domains (application, infrastructure, integration, and/or security) + Formal Enterprise Architecture… more
- Prime Therapeutics (Harrisburg, PA)
- …Yellow Belt or higher + Experience working at a Pharmacy Benefit Management ( PBM ), healthcare, or other complex organization in a highly regulated industry + ... Experience working as a practitioner in project management, program management, release management, business analysis, business architecture, agile, or SAFe (Scaled Agile Framework) **Physical Demands** + Ability to travel up to 10% of the time + Ability to… more
- Prime Therapeutics (Harrisburg, PA)
- …communication skills + Highly analytical and research oriented **Preferred Qualifications** + PBM or healthcare experience + Advanced Python or SAS experience + ... Master's degree (eg, MS, MPH) or equivalent work experience **Physical Demands** + Ability to travel up to 10% of the time + Constantly required to sit, use hands to handle or feel, talk and hear + Frequently required to reach with hands and arms +… more
- UPMC (Harrisburg, PA)
- …with Federal and State laws such as HIPAA, regulations such as OSHA, and PBM contracting requirements such as FWA and CMS. + General: Practice appropriate hand ... hygiene both in the pharmacy and in the units. + Distribution: Develop and maintain positive and productive service relationship during medication distribution process. + General: Use computer skills to process and maintain all patient information and records.… more
- Highmark Health (Wexford, PA)
- …all preauthorization entries into applicable databases (ie internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services ... deemed medically necessary. (20%) + Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements among others. (5%) + May perform other non-clinical… more
- Prime Therapeutics (Harrisburg, PA)
- …identify and remove obstacles to delivery/progress **Preferred Qualifications** + PBM /health care experience + Experience working on cross-functional teams aligned ... to a strategic priority, + Experience implementing new tools, platforms and products + Experience using queries, thorough understanding of pharmaceutical claims data and general understanding of medical claims data; highly analytical **Physical Demands** +… more
- CVS Health (Harrisburg, PA)
- …of AS400. Experience with either of these systems or prior exposure to the PBM or Medicaid industry would be advantageous. The ability to think critically and ... multitask is very valuable in this role. Additionally, you will be an integral part of recurring client meetings. You must be comfortable and adept with clearly communicating technical information (verbal and written) to non-technical people and leading… more
- UPMC (Pittsburgh, PA)
- …with Federal and State laws (such as HIPAA), regulations (such as OSHA), and PBM contracting requirements (such as FWA and CMS). + Practice appropriate hand hygiene ... both in the pharmacy and in the units. + Use computer skills to process and maintain all patient information and records. 2. Distribution: + Participate in the distribution of medication, including medication cassettes, emergency medication carts, and the… more