- Tetrad Digital Integrity LLC (Washington, DC)
- …claims processing, enrollment and eligibility platforms, Pharmacy Benefit Manager ( PBM ) integrations, CRM and call center platforms and care/case management ... systems + Design secure integrations patterns (API's, middleware, EDI batch and event driven) + Ensure alignment with enterprise architecture standards, interoperability requirements, scalability and resiliency objectives + Develop and deliver executive level… more
- Lowe's (Mooresville, NC)
- …Serves as the collaboration consultant for key initiatives like LowesForPros.com, PBM , new programs or field organization communities on connections **Minimum ... Qualifications** + Associate degree Business Administration, Communication, Education/Training, or related field or equivalent years of experience in lieu of education requirement, if applicable + Bachelor's degree Business Administration, Communication,… more
- Molina Healthcare (Tampa, FL)
- …with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager ( PBM ) for pharmacy contractually delegated functions. * Responsible for key performance ... indicators (KPI) reporting to department leadership on a monthly basis. * Participates, researches, and validates materials for both internal and external program audits. * Acts as liaison to internal and external customers to ensure prompt resolution of… more
- Amneal Pharmaceuticals (Bridgewater, NJ)
- …access/customer-facing contracts including product purchase, supply, distribution, PBM , GPO, wholesaler/distribution, rebate/discount, and specialty pharmacy ... agreements. Provide legal guidance on contracting and strategy for established and newly launched products. more
- St. Luke's Health System (Boise, ID)
- …our members in identifying and navigating complex pharmacy benefits management ( PBM ) and third-party issues such as prior authorization, step therapy, reviewing ... denied claims, and processing overrides. Works with an interdisciplinary team of pharmacy staff, patient financial advocates, the pharmacy authorization team, clinic staff, and providers. Issues insurance overrides and processes prior authorizations. **What to… more
- Guidehouse (Boston, MA)
- …**Integration Testing** : Confirm HL7/FHIR message integrity across labs, imaging, MIIS, PBM claims, and SOPS Meta. + **Security Testing** : Validate role-based ... access, HIPAA, and 42 CFR Part 2 compliance. + **Accessibility Testing** : Confirm WCAG 2.1 AA standards for behavioral health and vulnerable populations. + **Charge and Claims Testing** : Validate financial workflows and payer adjudication. + **Parallel… more
- Adecco US, Inc. (Pine Brook, NJ)
- …of experience working as a Pharmacist in a fulfillment and/or mail order environment * PBM or Managed Care experience **Why work for Adecco?** + Weekly Pay on Friday ... + 401(k) Plan + Skills Training + Excellent medical, dental, and vision benefits IMPORTANT: This Pharmacist job is being recruited for by Adecco's Healthcare & Life Sciences division, not your local Adecco Branch Office. For opportunities available at Adecco… 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. + Procure and maintain adequate inventory ... levels on daily basis in applicable areas such pharmacy medication stock rooms, automated medication carousels, and automated dispensing machines. + Maintain and update automated med stations, unit and department stock, emergency boxes, and crash carts. +… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Vendor Migrations** + Lead complex, mission-critical transitions: TPA migrations, PBM transitions, benefits administration platform upgrades, CRM implementations + ... Develop comprehensive migration playbooks covering: requirements gathering, vendor selection, contract negotiation, implementation planning, testing protocols, cutover execution, and stabilization + Establish program governance with executive steering,… more
- Walgreens (Pittsburgh, PA)
- …Qualifications:** + Experience providing customer service in a healthcare, specialty pharmacy, PBM , call center setting or other related industry including but not ... limited to adherence, quality, etc. + Experience in identifying operational issues and recommending and implementing strategies to resolve problems. + Familiarity of medical terminology, prescriptions, and pharmacy regulations. + Intermediate level PC skills,… more
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