Pharmacist

• Support patients on anticoagulation therapy across Colorado and Montana
• Facilitate medication access and resolve barriers
• Collaborate with pharmacists and providers for safe patient care
• Coordinate lab monitoring and adhere to provider recommendations
• Manage applications for home monitoring devices and related services
• Perform clinic administrative tasks, including scheduling visits

Pharmacy Technician – Anticoagulation

• Determines the suitability of individual patients for home care
• Collects and organizes all patient-specific information needed to determine the suitability of patients for home care
• Assesses patients' suitability for home care in accordance with Option Care policies
• Designs, recommends, monitors and evaluates patient-specific pharmacy care plans for the pharmacotherapy of home care patients
• Provides medication-use education to Option Care staff, other professionals, home care patients and/or their caregivers
• Participates in the process for assessing, managing, and reporting medication-related incidents and equipment error and/or failures
• Maintains confidentiality of patient and proprietary information

Clinical Pharmacist

• Perform care management activities for members with complex and chronic care needs
• Ensure high quality, cost-effective care and appropriateness of treatment
• Partner with physicians and/or pharmacists to interpret appropriateness of care
• Collaborate with providers to assess consumer needs and plan for adverse events
• Conduct clinical assessments to develop individual care plans and goals
• Monitor and evaluate effectiveness of care management plans

Clinical Nurse Coordinator – Telephonic

• Provide consultations through the patient's preferred method of communication (text, app messaging, email, or phone)• Perform initial assessments by gathering/reviewing chart notes to determine appropriateness of prescribing patterns• Perform clinical check-ins to monitor adherence, efficacy, adverse reactions, and drug interactions• Identify patients in need of clinical interventions and work collaboratively with providers to provide therapeutic recommendations resulting in improved patient outcomes• Ensure transition of care by transferring out prescriptions to appropriate pharmacies in situations where Alto is unable to fulfill a patient’s prescription• Being responsible for communicating prescription statuses to patients and providers• Work closely with Specialty Operations to provide quality care through the following:• Maintain an in-depth understanding of pharmacy billing including but not limited to Medicaid, Medicare, ADAP, commercial insurance, and foundation assistance programs to help troubleshoot patient cost barriers• Proactively identify and communicate areas of concern regarding scheduling/delivery procedures• Develop and provide drug information material designed to enhance Specialty Operations’ performance• Stay abreast of relevant and evolving regulatory and industry standards, ensure that appropriate action is initiated, and communicate these trends to applicable personnel• Work interactively with a local and/or dispersed team to achieve company business and compliance goals/objectives

Patient Care Pharmacist – Short Term Assignment

• Conducts benefits investigations for all new patients and existing patients with insurance changes to determine coverage for enteral nutrition products and services
• Ensures all required documentation—including initial and ongoing forms—is accurately completed, clearly legible, and filed in the patient chart in accordance with Amerita’s Enteral Nutrition Requirements
• Coordinates and schedules the timely dispensing of enteral formulas and supplies; actively manages inventory and patient support throughout the course of care
• Obtains and documents patient supply inventories and compliance updates and communicates relevant information to appropriate clinical and operational teams
• Monitors and follows up on active insurance authorizations, physician orders, clinical documentation, and outstanding paperwork to ensure continuity of care
• Triages patient concerns and routes to clinical staff as needed, using established screening protocols
• Actively participates in departmental meetings, branch operations and quality improvement initiatives as assigned
• Complies with all applicable Accreditation, OSHA, FDA, state, local and federal regulations related to infusion pharmacy and home medical equipment

Enteral Technician – Infusion Pharmacy

• Verify and dispense medications within corporate and regulatory guidelines
• Track order status
• Provide oversight and quality assurance to pharmacy technicians
• Interpret physicians’ or prescribers’ prescriptions
• Verify and confirm validity of controlled substances
• Back up other pharmacists as needed
• Perform additional duties as assigned by management
• Train less experienced pharmacists

Per Diem Staff Pharmacist

• Verifies member information and inputs data for the pharmacists
• Serves as mentor for less experienced staff
• Serves as department representative on intra-departmental initiatives
• Assists in formal training of associates and process improvement initiatives
• Conducts reviews by utilizing appropriate scripted algorithms in compliance with department guidelines
• Develops working partnerships with physicians and healthcare service providers
• Refers treatment plans to peer clinical reviewers in accordance with established criteria/guidelines

Pharmacy Technician II, BioPlus Specialty Pharmacy

• Collaborating with healthcare providers and/or pharmacists
• Driving personalized health management and improving health outcomes
• Performing care management activities within the scope of licensure
• Ensuring medically appropriate, high quality, cost-effective care
• Interpreting appropriateness of care and intervention planning
• Conducting clinical assessment to develop and implement care plans
• Monitoring and evaluating effectiveness of care management plans

Telephonic Clinical Nurse Coordinator – BioPlus Specialty Pharmacy

• Perform outbound and inbound medication adherence outreach (e.g., refill reminders, gaps‑in‑therapy follow‑up) using approved scripts and workflows
• Identify and document adherence barriers (cost, access, side effects, understanding) and escalate clinical concerns to a pharmacist or clinician
• Coordinate refills, prior authorization follow‑ups (as assigned), and pharmacy transfers in partnership with pharmacists
• Support population‑based adherence campaigns aligned to quality measures and organizational priorities
• Collaborate with interdisciplinary teams (Pharmacy, Care Management, Population Health) to close care gaps
• Adhere to all Intermountain policies, privacy standards, and medication‑related procedures

Pharmacy Technician – Population Health

• Fills and delivers/dispenses medications under the supervision of a licensed pharmacist.
• Performs introductory technical tasks in specialty areas such as medication histories, sterile and non-sterile preparation, payer adjudication, call center, clinical pharmacy support, inventory management including controlled substance handling and accountability, and repackaging.
• Uses appropriate systems for processing of patient information.
• Triages and escalates any questions or issues outside the pharmacy technician scope of practice to the staff pharmacist or supervisor as needed.
• Ensures adequate supplies are available for continuous patient care.
• Operates pharmacy equipment appropriately.

Pharmacy Technician II – Correctional Care

• Manage anticoagulation therapy under collaborative practice agreement for patients in Colorado and Montana
• Collaborate with the healthcare team to ensure safe, high-quality care and effective medication monitoring
• Act as a clinical resource to support safe anticoagulation practices
• Provide drug information to patients and medical providers
• Address and resolve medication related problems

Clinical Pharmacist – Anticoagulation

• Performs supervisor/leadership functions over the Denver Health Medical Plan (DHMP) / Managed Care Pharmacy clinical pharmacist and administrative staff.
• Applies critical thinking, clinical knowledge, evidence-based policies, procedures, guidelines, and competence to collaborate with the team to promote excellence and quality outcomes.
• Provides operational and collaborative leadership for the Managed Care Pharmacy Department.
• Maximizes efficiency and positively impacts the care provided to members.
• Collaborates with different teams within the organization.
• Leads the development of specific departmental goals, standards, and objectives that directly support the strategic plan and vision of the organization.
• Promotes department sustainability and cost containment efforts to achieve budget.
• Identifies and implements strategies to monitor variance reports to enhance productivity while maintaining high-quality service.
• Implements programs that promote high motivation among team members by coaching, counseling, and setting goals for direct reports.
• Supervises Pharmacist Clinical Specialist and Pharmacy Technician Call Center staff.
• Sets and communicates expectations to each employee and establishes job requirements and performance appraisal components.
• Regularly provides individual assessments to ensure timely feedback on performance expectations.
• Performs timeliness monitoring, prior authorization, and call center auditing, and presents annual reports to the Medical Management Committee (MMC) and Quality Management Committee (QMC).

Pharmacy Supervisor

• Completes and submits re-authorizations for patients
• Enters re-authorizations into the portal with accuracy
• Maintains log of all re-authorizations submitted
• Follows up with insurance companies for approval/denial status

Authorization Representative I – BioPlus Specialty Pharmacy

• Provide integrated support to patients and physicians by providing a hands-on approach to improve the quality of patient care.
• Help advance quality pharmacotherapy care by actively assuring the provision of safe, efficacious, and cost-effective drug therapy.
• Collaborate closely with the hybrid ACP team to maximize full suite of therapy management (TM) clinical services within supported clinics.
• Perform in-person and/or virtual/phone assessments on disease state management and drug therapy education stratified based on medication risk level and approved clinic protocol.
• Focus to identify, resolve, and prevent medication-related problems.
• Offer additional services to overcome identified barriers to medication compliance and any other obstacle related to adherence.
• Monitor and evaluate medication regimens to ensure clinical criteria are met, including therapeutic goals, adverse effects, and drug interactions.
• Identify opportunities for drug therapy optimization and provide recommendations for medication cost savings initiatives when applicable.
• Participate in quality improvement initiatives by actively participating in clinical outcome studies, REMs compliance/reporting, and ACP-related process improvement projects.
• Optimize resources and workflows with supporting roles handling complex prior authorizations/appeals by providing clinical justification for medication approval, including supporting literature and rationale.
• Collaborate with healthcare providers, including assigned clinic physicians, specialists, and onsite clinic pharmacists, to ensure seamless medication management and coordination of care.

Ambulatory Clinical Pharmacist

• Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
• Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations
• Participate in clinical quality audits and inter-rater reliability testing
• Provide internal team support for escalations and questions
• Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Prior Authorization Pharmacist

• Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and properly track pharmacy prior authorization requests
• Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information
• Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria, clearly documenting all communication and decision making
• Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
• Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for content and accuracy
• Compliance with all applicable laws and regulations
• Other duties as assigned

Prior Authorization Pharmacy Technician

• Troubleshooting electronic, faxed, and verbal prescriptions via routing to appropriate channels into pharmacy systems
• Review and update patient insurance using payer portals and phone resources
• Determining appropriate situations for a prior authorization (PAs) need via payer-specific tools; troubleshoot denials and escalations
• Utilize reroute best practices for orders falling outside normal workflow, including orders with state changes, insurance exceptions, pharmacy rejections, or failed transfers
• Navigate operational platforms (e.g., BestRx, Ops Dash, Partner Dash, RelayHealth, etc.) and vendor systems effectively
• Follow reroute protocols for specific tags including: non-contracted pharmacies, state shipping changes, PP send-backs, transfer not received, and more
• Proactively document process notes with clear routing details, claim updates, and actions taken
• Communicate with partner pharmacies, provider offices, and insurance carriers to resolve issues or clarify documentation
• Collaborate with At-Risk, Partner Management, and PPM teams to escalate or flag orders based on system outages, stock issues, or policy refusals
• Maintain productivity in the Reroute queue even during extended call hold times (e.g., multitask during insurance calls)
• Ensure all patient, prescriber, and partner communications are clear, professional, and aligned with Phil’s standards of care

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