- Corewell Health (Grand Rapids, MI)
- …questions. Educates customers on drug formulary guidelines, including drug formulary alternatives and prior authorization criteria. Consistently create an ... promptly provides customers with information and education concerning the drug formulary and prior authorization (coverage determination) requests and ensuring… more
- J&J Family of Companies (Columbus, OH)
- …(coding, coverage, and payment) + Extensive experience in revenue cycle, buy-and-bill, formulary , prior authorization, coding, and appeals processes. + A valid ... Medicare treatment guidelines, Medicaid Managed Care, commercial plans, policy changes, formulary status and the impact of healthcare reform on coverage. Maintain… more
- CareOregon (Portland, OR)
- …Technician Certification. Core responsibilities include customer service, claims processing, prior authorizations, formulary exceptions, appeals, grievances, and ... materials to members, providers or pharmacies, letters & mailings, and reports. Prior Authorizations (PA) and Formulary Exceptions + Verify member's plan… more
- Veterans Affairs, Veterans Health Administration (Asheville, NC)
- …Pharmacy experience , familiar with VistA and CPRS, and experience with formulary management and adjudicating Prior Authorization drug requests, medication ... (electronic prescriptions, faxes, hardcopies, controlled substances, etc.), medication reconciliation, formulary management and professional communication with external providers as… more
- Hackensack Meridian Health (Neptune, NJ)
- …and medication costs through coordination of benefits, assistance with prior authorization, formulary adherence, avoiding unnecessary and/or duplicate ... post-discharge period. 9. Identify additional therapies needed or therapies no longer needed prior to discharge. 10. Assists with staffing as deemed necessary by the… more
- University of Rochester (Rochester, NY)
- …providers. - Conducts phone calls for verification/confirmation, insurance medication formulary and pharmacy benefits clarification, prior authorizations, and ... REDCap is desirable (preferred). Trauma-Informed Care training/certification/knowledge desired (preferred). Prior experience with home visiting interventions valued (preferred). Spanish… more
- BrightSpring Health Services (Morton Grove, IL)
- …by maintaining a high productivity level and an error-free workproduct. + Maintain formulary documents and tools. Qualifications + Prior data entry experience. + ... Familiarity with pharmacy systems. + Familiarity with standard pharmacy concepts, practices, and procedures. + Exceptionally strong verbal communication skills, with special emphasis on effective telephone correspondence. + Familiarity with Microsoft Excel. +… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …Market Access account managers and the contracted account to gain alignment on formulary product placement and compliance and to recover previously paid rebate or ... discounts in the event of noncompliant formulary findings. **How you'll spend your day** + Review Managed Care Contracts, Formularies, Utilization Management, and PA… more
- Prime Therapeutics (Columbus, OH)
- …procedures, policies, guidelines, and work instructions. **Job Description** + Provides prior -authorization services for formulary drugs, develops programs to ... other clinical personnel in assessing treatment guidelines. May participate in formulary development and management. Supports the national Pharmacy and Therapeutics… more
- The Cigna Group (Morris Plains, NJ)
- …position is responsible for the oversite of implementation activities related to formulary management and utilization management on the pharmacy and medical benefit ... management of the clinical pharmacists who work to support formulary management activities as well as oversight of key...employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states… more
- The Cigna Group (St. Louis, MO)
- …acumen to advise functional leaders and educate other team members. Delivers formulary consulting clinical modeling support, but also works on broader projects, ... department internally and externally serving as conduit to educate downstream formulary consulting stakeholders resulting in an optimal formulary consulting… more
- The Cigna Group (Morris Plains, NJ)
- …at an office location with occasional travel. **Job Description:** Supply Chain - Formulary Development Residency + Our residency is a 12-month holistic program that ... a robust foundation in managed care, specifically with a focus in formulary development, management and operational execution. The resident will have opportunities… more
- CVS Health (Austin, TX)
- …with CVS Health. This position is for a Clinical Pharmacist working in the Prior Authorization team. - Collaborates with the technicians and prior authorization ... within the designated service level agreements. - Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria… more
- Actalent (Bloomington, MN)
- …nurses) as well as pharmacies with regard to pharmacy benefits, pharmacy claims, formulary , and pharmacy policy and procedures. Will not be talking to members. ... and working with difficult customers in-person and via telephone; or 3 years Prior Authorization and pharmacy benefit experience at a pharmacy benefit company or… more
- The Cigna Group (Philadelphia, PA)
- …in this posting.** **RESPONSIBILITIES:** + Responsible for the commercial formulary change process evaluating pharmacy and medical drug strategy opportunities ... and formulary product enhancements to drive pharmacy affordability to Cigna...employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states… more
- UNC Health Care (Morrisville, NC)
- …communities we serve. Summary: Pharmacy Benefit Management Pharmacist will develop formulary and drug utilization management strategies that will be implemented for ... inappropriate utilization and optimize drug spend. Responsibilities: + Coordinate formulary management including business committee decision making and implementation,… more
- Pfizer (New York, NY)
- …for HCPs/office staff regarding local/regional payer landscape, payer coverage and formulary change updates, payer policies (eg, prior authorization, step ... edits, specialty pharmacy coverage) and patient support + Coordinate reauthorization process at designated accounts to ensure timely reauthorization and continuation of therapy is maintained + Distribute Pfizer RC-approved materials to HCPs/office staff… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …and clinical information necessary for coverage determinations + Explain the Plan's formulary , formulary structure and different benefit stages + Enter and ... maintain accurate prior authorization records + Answer provider calls as this...physicians regarding use of medications and advise of appropriate formulary alternatives when requested + Respond to inquiries from… more
- The Cigna Group (Bloomfield, CT)
- …Trend Consultation and Execution + Holistic clinical solution opportunities + Formulary , Utilization Management, and Rebate opportunities + Support of the above ... for multiple clients **Rotations** + Orientation [focused] + Research [longitudinal] + Formulary Strategy I - Commercial [focused] + Pharmacy & Medical Trend… more
- Billings Clinic (Billings, MT)
- …must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) ... drugs to help determine if they will be added to the formulary . (Patient Care, Pharmacy, Formulary Planning) Acts as a preceptor for pharmacy students and PGY1… more