- Elevance Health (Columbus, OH)
- ** Process Expert I - PBM ** L _ocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of ... a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. The ** Process Expert I** assists in identifying and researching workflow… more
- Elevance Health (Mason, OH)
- **JR128086 PBM Compliance Manager (Accreditation)** Responsible for coordinating pharmacy accreditation and compliance activities and initiatives across the PBM ... ensure compliance with all related measures. + Identifies potential risks associated with PBM activities and ensures procedures are in place to minimize risks. +… more
- Elevance Health (Mendota Heights, MN)
- **Staff VP PBM Pricing and Underwriting** **Location:** Located within commuting distance to an Elevance Health office in: IN, GA, IL, MN, CT. **Summary** A proud ... deliver member-centered, lasting pharmacy care. The Staff VP of PBM Pricing and Underwriting will be responsible for overseeing...and track deals accordingly. + Acts as subject matter expert on the technical aspects of Rx pricing and… more
- University of Utah Health (Salt Lake City, UT)
- …curriculum. + Coordinates system-level transfusion and blood management governance. + Provides expert PBM consultation and advice to sponsors, champions, and ... statistics. + Collaborates with sibling departments to execute system level process improvement. + Monitors PBM program performance, established metrics,… more
- Medical Mutual of Ohio (OH)
- …review and resolution either directly or forwards/escalates to other departments or PBM . Monitors paid claims for accuracy including for transition supply oversight. ... on member experience. Conducts outreach to Pharmacy Benefit Manager ( PBM ) for refills, claim reprocessing and to members to...needed. . Assists more junior level with any oversight process questions. . Performs other duties as assigned. **Senior… more
- Prime Therapeutics (Columbus, OH)
- …to a variety of complex problems + Drive enterprise-wide transformation and process improvement to financial pricing analytics processes and programs + Other duties ... financial analysis to include 5 years of experience in Pharmacy Benefit Management ( PBM ), claims processing, healthcare, and/or related field + 3 years of experience… more
- Novant Health (Winston Salem, NC)
- …Specialist at Novant Health works closely with the Pharmacy Benefits Manager ( PBM ), Benefits Consultant(s), and the People and Culture team to provide Novant ... pinpointing opportunities for clinical programs, and acting as the go-to expert on pharmacy benefits. In addition, the specialist designs educational initiatives… more
- CareOregon (Portland, OR)
- …and updating stakeholders. + Regularly interface with the Pharmacy Benefit Manager ( PBM ) to implement, validate and trouble shoot pharmacy benefit claims processing ... set-up and maintenance requirements. + Perform delegation oversight functions of the PBM to ensure that contractual and regulatory requirements are met. + Develop… more
- Prime Therapeutics (Eagan, MN)
- …The Associate Functional Business Consultant serves as a business system or business process subject matter expert for their assigned area. This position will ... accountabilities. **Responsibilities:** + Represents assigned business system or business process as a subject matter expert in...years related work experience, to include: + 2+ years PBM or healthcare industry experience, including 1+ year of… more
- Prime Therapeutics (Columbus, OH)
- …and across the organization. **Responsibilities** + Collaborate as a subject matter expert (SME) with underwriters, other areas of Prime, and senior management on ... initiatives, data analyses, and the Request For Proposal (RFP) process + Lead, manage, and review data analyses, reporting,...to include 6 years in a healthcare organization or PBM + Actuarial designation (ASA or FSA) + Must… more
- The Cigna Group (St. Louis, MO)
- …/ Health Care Reform). The team supports Pharmacy Benefit Management ( PBM ) delegated responsibilities associated with Call Center and Grievances oversight, ... professional input to complex assignments/projects. + Works autonomously, only requiring " expert " level technical support from others. + Facilitates the intake,… more
- The Cigna Group (Bloomfield, CT)
- …Development is a dynamic role within Evernorth's Pharmacy Benefit Management ( PBM ) division that provides primary direction, leadership, and strategy around changes ... ensure an affordable and predictable benefit for Medicare beneficiaries. Leads the PBM through changes to Medicare benefits to ensure competitiveness and appropriate… more
- Veterans Affairs, Veterans Health Administration (Oakland Park, FL)
- …Hematology/Oncology Clinical Pharmacist Specialist (Hem/One CPS) serves as a medication expert and team member on Hematology/Oncology patient care teams. Assist with ... Selected applicants will be required to complete an online onboarding process . Must pass pre-employment physical examination. Participation in the seasonal influenza… more
- Elevance Health (Columbus, OH)
- …serve as an Associate General Counsel Sr. to CarelonRx, a pharmacy benefits manager ( PBM ) owned by Elevance Health. This position will be responsible for serving as ... a subject matter expert on pharmacy law, specifically infusion and specialty Pharmacies,...onsite will be discussed as part of the hiring process . Candidates must reside within 50 miles or 1-hour… more
- Veterans Affairs, Veterans Health Administration (Honolulu, HI)
- …Maintains current knowledge, responsibility, understanding and oversight of all VISN 21 PBM , local and national performance measures in areas of assignment. Provides ... Selected applicants will be required to complete an online onboarding process . Participation in the seasonal influenza vaccination program is a requirement… more
- Prime Therapeutics (Columbus, OH)
- …solutions to complex problems and lead cross-functional projects. **Responsibilities** + Serves as expert consultant and subject matter expert in the company for ... and experts from multiple teams to design and implement complex DR process interfaces and their enablement within multiple applications and tools + Functions… more
- Takeda Pharmaceuticals (Boston, MA)
- By clicking the "Apply" button, I understand that my employment application process with Takeda will commence and that the information I provide in my application ... oncology business in the US, including but not limited to: + Provide an expert , strategic view on the evolving environment and competitive access landscape to inform… more
- Elevance Health (Norfolk, VA)
- …direction and guidance to team members and serves as an expert for Legal/Executive/Regulatory Decision Special Handling Instructions requirements. + Provide ... direction and guidance to team members and serves as an expert of prior authorization requirements including workflows, letters, timers, reporting, and electronic PA… more
- The Cigna Group (Bloomfield, CT)
- …respective manufacturer portfolio. The Director is required to be a subject matter expert of their Pharma contracts and have a solid understanding of Specialty ... Anticipates internal and/or external business challenges and/or regulatory issues; recommends process , product or service improvements. + Solves unique and complex… more
- The Cigna Group (Philadelphia, PA)
- …to identify and drive not only modeling improvements but also overall process improvements in the retail network and Supply Chain areas. Internally recognized ... and trusted as the retail network subject matter expert . **Essential Functions** + Collaborate with SAM and Core...to work with various matrix partners + Knowledge of PBM or Healthcare industry preferred If you will be… more