- 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 company ... Ensure accuracy of case setup and clinical review of Medicare appeals cases . Review internal notes or fax...a rotating schedule including overtime, weekends, and holidays Clinical Pharmacist Preferred Qualifications . This is a remote… more
- US Tech Solutions (May, OK)
- **Job Title:** **Prior Authorization Pharmacist ** **Location: Remote ** **Duration: 6+ months contract** **Job Description:** + Responsible for reviewing and ... position. **Skills:** + MUST HAVE MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE 6 months of experienced...required with at least two years experience as a pharmacist in Managed care environment. + Must have an… more
- Healthfirst (NY)
- …of medications + Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health ... degree from an accredited school of pharmacy + Registered Pharmacist with a state license in good standing. +...Residency + Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to… more
- Healthfirst (NY)
- …and 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) ... degree from an accredited school of pharmacy + Registered Pharmacist , with a state license in good standing +...opportunities + Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to… 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 ...Pharmacist ** , within the scope of the Ohio Pharmacist Practice Act, will provide timely, accurate, cost effective,… more
- US Tech Solutions (May, OK)
- …for this position. **Skills:** **Prior Authorization** **Pharmacy Benefit Management** ** Medicare Part D** **Education:** High School Diploma or GED required. ... pharmacy or Pharm D. also required with at least two years' experience as a pharmacist . Must have an active license in the state of residence in good standing.… 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...duties as assigned including on call and after hours pharmacist availability could be required. (10%) **Experience:** + … more
- Centene Corporation (Tallahassee, FL)
- …and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D and the Health Information Marketplace + Develop drug product ... pharmacy or pharmacy residency program experience. **Licenses/Certifications:** Current state's Pharmacist license with no restrictions.Pay Range: $103,500.00 - $191,600.00… more
- Prime Therapeutics (Columbus, OH)
- …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...and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations… 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... products. + Leads the setup and monitoring of Medicare pharmacy benefits and PDE accuracy in collaboration with… more
- CareFirst (Baltimore, MD)
- …implementing the organization's pharmacy vision and strategic plan for government programs ( Medicare and Medicaid). This role has oversight of pharmacy staff and ... with the Maryland Department of Health (MDH) and US Centers for Medicare and Medicaid Services (CMS). **ESSENTIAL FUNCTIONS:** + Provides oversight and support… 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 ... activities and align pharmacy services with improvement quality metrics and Medicare part D performance. + Collaborate with stakeholders to improve pharmacy-directed… 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 ... Programs and/or experience as a supervisor/manager a plus. + Knowledgeable with Medicare , Medicare Part D benefits, and Stars Program. + Demonstrated ability to… more
- Prime Therapeutics (Columbus, OH)
- …**Job Posting Title** Director, Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description Summary** Responsible for support and development of ... legislative/oversight bodies (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA-National Committee for Quality Assurance,… more
- Centene Corporation (Tallahassee, FL)
- …of all operations by working closely with external vendors, manager(s), clinical pharmacist (s), and other support staff. High priority is placed on seeking ... + Manages corporate QI Trilogy documents for Medicaid / Medicare and UMAC/QIC across entire pharmacy organization for all...Experience:** Required 7+ years of experience in a licensed pharmacist role, OR completion of PGY-1 residency program +… more
- US Tech Solutions (RI)
- **Job Title: Prior Authorization Specialist** **Location: Fully remote ** **Duration: 12 months contract** **Job Description:** + Prior Authorization Specialist takes ... all clinical questions, escalations and judgement calls to the pharmacist team. + The Rep I, Clinical Services will...clients or lines of business and in accordance with Medicare Part D CMS Regulations. + Must apply information… more
- State of Michigan (MI)
- …to perform survey and certification activities on behalf of the Centers for Medicare and Medicaid Services (CMS). The health care surveyor position performs surveys ... licensed psychologist, licensed physical therapist, licensed occupational therapist, licensed pharmacist , registered social worker, and certification of gerontology). Some… 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 following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center, Medicare Part D/Part B, Appeals, Medicare Part D Operations and ... Regional Medical Director on related issues. + Prior Authorization Medicare Part D and Part B + Tracks and...authorization requests submitted from providers and determine if a pharmacist review is required + Obtains verbal authorizations and… more
