- Actalent (Atlanta, GA)
- …advising them PLUS++: 1. prior authorization experience 2. experience working in PBM 3. MTM experience 4. Lexicomp experience 5. Ambulatory pharmacy experience 6. ... Experience with EPIC and other EMRs Job Type & Location This is a Contract position based out of ATLANTA, GA. Pay and Benefits The pay range for this position is $50.00 - $55.00/hr. Eligibility requirements apply to some benefits and may depend on your job… more
- Actalent (Fairfield, NJ)
- …as a Pharmacist in a fulfillment and/or mail order environment. + Experience with PBM or Managed Care. Work Environment This role primarily involves working in a ... standing or walking environment. The schedule is primarily from Sunday to Thursday, with flexibility required for extended hours and potential first shift work. The position involves using advanced pharmacy technologies and automation to ensure accurate and… more
- Centene Corporation (Newark, DE)
- …+ Maintain client setup and benefit configuration by entering benefit information into PBM system + Track and process various change requests from the benefit ... enrollment forms and other system queues timely and accurately + Research system issues and update information of commercial accounts and submit deliverables to account management team + Assist with testing and system setup + Process enrollment and termination… more
- UPMC (Williamsport, PA)
- …with Federal and State laws such as HIPAA, regulations such as OSHA, and PBM contracting requirements such as FWA and CMS. + Filling: Assist in the preparation ... of the proper oral and injectable medications (including intravenous admixtures and TPN (Total Parenteral Nutrition)) for the correct patient for administration at the appropriate time. Use proper technique in the preparation of medications. + General:… more
- Insight Global (Bloomington, MN)
- …teams (end users/business partners) * Pharmacy data experience working with another PBM * Knowledge of health care operations * Exposure to agile/scrum (including ... tools like JIRA) * Experience using Azure Data Lake, DevOps, Power Automate, or other tools in the Azure Suite * Working knowledge of medical terminology, medical coding systems; ICD-10, CPT4, DRG, GPI. Familiarity with software development, data and… more
- Cleveland Clinic (Beachwood, OH)
- …specialty pharmacy insurances, including Medicare, Medicaid, Pharmacy Benefit Managers ( PBM ), and Preferred Provider Organizations (PPO) and communicates with payors ... and advises patients or physician of results as needed. + Communicate with patients professionally and customer-friendly to schedule the delivery of new and refilled medications and supplies. + Utilize all pharmacy systems to review patient profiles, enter… more
- AbbVie (North Chicago, IL)
- …experience within a Specialty Pharmacy or Retail/Mail Order Pharmacy, PBM , or healthcare provider setting; familiarity with medical record handling/documentation; ... prescription data entry; high quality customer service and inter-professional communication; strong core insurance (Medical and Pharmacy benefit) knowledge; knowledge of on-line verification systems or similar experience is preferred. + Must have a strong… 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. + Note: The above statements are ... intended to describe the general nature and level of work being performed by people assigned this job. They are not exhaustive lists of all duties, responsibilities, knowledge, skills, abilities and working conditions associated with the job. + Completion of… more
- Health Care Service Corporation (Chicago, IL)
- …actuarial projections and financial results. * Provide actuarial support for annual PBM market checks and negotiations. * Identify key financial risks and ... opportunities, proactively communicating insights and recommendations to executive leadership. **_Market Intelligence & Strategic Insights_** * Lead Medicare Part D market intelligence, including competitor analysis, CMS policy changes, regulatory guidance,… more
- CareFirst (Baltimore, MD)
- …the departmental budget. + Serves as a point of contact for CareFirsts PBM vendor and other strategic pharmacy vendor partnerships. Ensures vendors execute contract ... terms. Identifies and implements vendor programs based on CareFirsts needs such as quality initiatives, compliance, population health, and/or member/provider experience. + Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify… more
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