- Molina Healthcare (New York, NY)
- **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs… more
- Mount Sinai Health System (New York, NY)
- …the WTCH clinic population. The Clinical Pharmacy Manager will act as the pharmacy representative for the WTCHP clinic(s) in coordination with other MSHS ... prescription portal for QA report and analyzing + Reviewing pharmacy claims to identify outliers, utilization and...supervisor, subject to reasonable accommodation . + Serve as pharmacy representative on behalf of MSHP as… more
- Prime Therapeutics (Trenton, NJ)
- …our passion and drives every decision we make. **Job Posting Title** Pharmacy Network Consultant Principal - Remote **Job Description** The Network Management ... Consultant is responsible for development and management of Prime's pharmacy networks, aligning with Prime's supply chain and network economic objectives. This… more
- Molina Healthcare (New York, NY)
- …or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to ... as they arise, making an assessment when escalation to a Senior Representative , Supervisor, or another Molina department is needed. Takes initiative in preventing… more
- VNS Health (Manhattan, NY)
- …to Fraud, Waste, and Abuse of Medicare/Medicaid services. + Collaborates with pharmacy services to review PBM activities and denial of prior authorizations, ... of care and member/provider satisfaction. + Acts as a representative of the VNS Health Plans and an advocate...physicians regarding medical policies, utilization management, gaps in care, claims editing, use of resources and quality. + Performs… more
- Pfizer (New York, NY)
- …change updates, payer policies (eg, prior authorization, step edits, specialty pharmacy coverage) and patient support. + Distribute Pfizer RC-approved materials to ... financial assistance brochures. + Reactively assisting HCP offices with coding and claims -related issues by contacting payers to understand policy or procedures and… more