- A-Line Staffing Solutions (Atlanta, GA)
- A-Line Staffing is now hiring a fully remote Clinical Pharmacist - Medicare D Advisor. The Clinical Pharmacist would be working for a Fortune 500 ... Responsibilities . Ensure accuracy of case setup and clinical review of Medicare appeals cases ....evenings, weekends, and holidays. If you think this fully remote Clinical Pharmacist position is… more
- Healthfirst (NY)
- …+ Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) ... units based on dosing, indication, weight, BMI and other clinical considerations + Develop clinical criteria and...degree from an accredited school of pharmacy + Registered Pharmacist with a state license in good standing. +… more
- Healthfirst (NY)
- …Students + Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) ... with the latest guidelines or otherwise supported by the clinical compendia + Provide clinical pharmacy support...degree from an accredited school of pharmacy + Registered Pharmacist , with a state license in good standing +… more
- Trinity Health (Columbus, OH)
- …, a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive outreach and ... at www.experiencecolumbus.com ! **About the job:** The **Patient Care Pharmacist ** , within the scope of the Ohio ...three years of institutional pharmacy experience in an advanced clinical setting is preferred + Effective Communication Skills +… more
- Centene Corporation (Tallahassee, FL)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace + Develop drug product… more
- US Tech Solutions (May, OK)
- …relevant literature. + Reviewed worker's compensation claims data for clinical appropriateness, cost efficiency, and therapeutic benefit. + Provided evidence-based ... for this position. **Skills:** **Prior Authorization** **Pharmacy Benefit Management** ** Medicare Part D** **Education:** High School Diploma or GED required.… more
- US Tech Solutions (AZ)
- **Job Title:** ** Pharmacist ** **Location: Remote ** **Duration: 12+ months contract** **Job Description:** + As an RPh Advisor you will be directly supporting ... Medicare Part D members and providers with requests related...cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to… more
- Prime Therapeutics (Columbus, OH)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Program Manager Remote **Job Description** **This Clinical Program ... Manager opening is presenting a unique opportunity for a Pharmacist that has PBM experience, likes to travel and...while being that utility player/SME of the department.** The Clinical Program Manager is responsible for the management of… more
- CenterWell (Columbus, OH)
- …market location(s) + Experience working in a value-based care, senior care, and/or Medicare managed care **Workstyle** This is a remote position with travel ... caring community and help us put health first** The National Director, Clinical Pharmacy is a strategic pharmacy leader responsible for developing, implementing, and… more
- Prime Therapeutics (Columbus, OH)
- …drives every decision we make. **Job Posting Title** Director, Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description Summary** Responsible ... clients and potential new clients. Required to serve as a Medical Pharmacy clinical resource throughout the organization and support all clinical pharmacy… more
- CareFirst (Baltimore, MD)
- …evaluation, and quality improvement activities. + Experience with developing and implementing clinical programs. + Experience with Medicare Part D and Medicaid ... implementing the organization's pharmacy vision and strategic plan for government programs ( Medicare and Medicaid). This role has oversight of pharmacy staff and… more
- Healthfirst (NY)
- …and/or issues as they relate to delegated functions. + Partner with the Medicare Pharmacist to increase provider engagement via benefit and policy updates. ... reporting and project specifications, job aids and workflows for Medicare products. + Leads the setup and monitoring of...Bid and Go-To Market projects in collaboration with the clinical pharmacy team. + Monitor and analyze key data… more
- Actalent (Dallas, TX)
- Actalent is Hiring Pharmacy Technicians for REMOTE Position! As a Pharmacy Technician in the Appeals department, you will primarily handle cases involving denied ... Prior Authorizations for Medicare and Medicaid patients. Your main responsibilities include reviewing...You will be expected to work independently in a remote setting, ensuring a distraction-free, HIPAA-compliant environment. Must Have:… more
- The Cigna Group (Nashville, TN)
- …Management team, and several Pharmacy Teams including the MTM Pharmacists, Embedded Pharmacist , and Population Health Pharmacists in providing this service all while ... goals and perform additional tasks as assigned by the Clinical Pharmacy Senior Manager and/or Director. + Communicate and...experience as a supervisor/manager a plus. + Knowledgeable with Medicare , Medicare Part D benefits, and Stars… more
- Centene Corporation (Tallahassee, FL)
- …daily oversight of all operations by working closely with external vendors, manager(s), clinical pharmacist (s), and other support staff. High priority is placed ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- US Tech Solutions (RI)
- …reviews. + Transfers all clinical questions, escalations and judgement calls to the pharmacist team. + The Rep I, Clinical Services will also assist with ... status and results (seniors, pharmacists, appeals, etc). + Identify and elevate clinical inquiries to the pharmacist team as appropriate. **Experience:** +… more
- Trinity Health (Boise, ID)
- …of the SAMG Population Health team and will work closely with the Pharmacist to execute strategies for the Population Health Pharmacy Value-Based Care incentive ... programs. The Pharmacist and Technician team will improve patients' medication adherence...Performance will be tracked monthly, quarterly, and yearly by Medicare STAR quality ratings. The Pharmacy Technician is also… more
- Centene Corporation (Phoenix, AZ)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... the following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center, Medicare Part D/Part B, Appeals, Medicare Part D Operations and… more
