Pharmacist

• Manages the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals.
• Serves as subject matter expert on contract terms including reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation.
• Tracks contract expirations, renewals, and amendments to ensure uninterrupted access and compliance.
• Analyzes reimbursement methodologies (AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, admin fees) and identifies reimbursement risks, underpayments, and revenue leakage.
• Partners with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes and supports forecasting, margin analysis, and payor profitability reporting.
• Translates contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic and coordinates with IT and pharmacy operations to ensure accurate setup of pricing and payor-specific rules (including NDC requirements, J-codes, modifiers, and site-of-care billing logic).
• Supports payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations.
• Ensures contracts comply with federal and state regulations including CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements; maintains audit-ready documentation; and supports internal/external audits.
• Acts as the primary contract resource for internal teams; provides contract education to support accurate billing and payor compliance; and supports payor escalations, access issues, and network participation inquiries.

Payor Contract Manager – Infusion

• Create and Maintain Clinical Criteria for applicable Utilization Management (UM) programs: Develop and maintain clinical criteria (access to Prime standard and BCBSNE specific versions); Develop and maintain criteria process flows; Develop and maintain physician fax forms and other modes of communication; Utilize predictive modeling tool to intervene with high-risk members for identified disease states; Provide clinical updates as necessary to internal staff and physician reviewers; Performs highly complex research, analysis and develops recommendations for UM programs & plan design changes.
• Responsible for Operational workflows and Completion of UM reviews: Clinical oversight of first level review process; Clinical review of utilization management reviews; Perform clinical support for Pharmacy Technician and other staff; Utilize reporting tools to create efficiencies by reviewing medical and pharmacy claims data; Support physician reviewers with information required to efficiently review non-approvable claims; Develop Decision Tree review process when applicable.
• Maintain URAC accreditation: Work with internal staff to ensure that URAC accreditation is maintained; The pharmacist will work within their scope of licensure and unless expressly allowed by state or federal law or regulation, are located in a state or territory of the United States when conducting drug utilization review. The clinical pharmacists may not conduct peer clinical review non-certifications for drug utilization management, if prohibited by state utilization management laws. The clinical pharmacists may not conduct peer clinical review non-certifications for drug utilization management if the requesting party specifically requests a clinical peer.
• Measure quality assurance reporting, turnaround time for urgent and non-urgent reviews and quantitative assessment of UM reviews by program.
• Support Medicare Advantage processes, outreach, presentations, and tasks that require clinical direction and support. This includes, but not limited to, clinical presentations to internal and external stakeholders, providers, provider offices, and other customers.

Clinical Pharmacist

• Audit prior authorization activities
• Identify opportunities for process improvement
• Support clinical training initiatives
• Help maintain the integrity of critical pharmacy systems and data
• Partner with business groups to identify and resolve errors in data and reporting
• Assist with the administration of audit processes and tools related to prior authorizations, appeals, quality improvement, star measurement reviews, inter-rater reliability and data entry
• Assess training needs and identify, select or develop appropriate training programs including training aids and materials
• Assist with training staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action
• Maintain records of training activities and employee progress
• Participate in Quality and Advisory committees or provider education meetings

Clinical Audit Coordinator, Pharmacy

• Deliver rapid quality and process improvement information to the technicians on their team
• Prepare material for and deliver in team meetings
• Serve as a subject matter expert for their team
• Provide guidance to pharmacy technicians on quality assurance monitoring and productivity standards
• Track and triage coverage determination requests submitted from providers
• Obtain verbal authorizations and request detailed clinical information from prescribers
• Approve coverage determination requests based on defined criteria
• Document coverage determination request decision into the PBM system and notify providers and/or members
• Respond to client inquiries regarding authorization approvals and PBM on-line applications
• Refer coverage determination requests for specialty drugs to delegated vendor or client for processing
• Perform other duties as assigned

Lead Pharmacy Technician

• Responsible for the direct daily supervision of pharmacy service representatives (PSRs)
• Provide proactive compliance and ordering calls for all medications dispensed by CVS/specialty Pharmacy Network
• Guidance and direction to staff
• Direct daily workflow, schedule preparation and management
• Ensure adherence to standard operating procedures
• Interviewing/hiring process, staff training, and performance monitoring
• Conduct audits, review metrics, and prepare scorecards

Supervisor, Specialty Pharmacy Services

• Participating in program management activities
• Supporting and facilitating the distribution of reports and communication documents
• Assisting with process improvement initiatives

Clinical Support Coordinator

• Assisting patients in receiving needed medications to help manage rare and/or chronic diseases
• Accurately enter prescriptions into our system
• Interact directly with healthcare providers
• Juggle multiple tasks without sacrificing attention to detail

Pharmacy Technician – PACE

• Provide direct pharmaceutical care services through patient and provider interactions
• Conduct face-to-face and virtual visits for chronic disease medication management
• Obtain comprehensive medical and medication histories
• Complete medication reconciliation and document interventions in the electronic medical record
• Initiate, modify, renew, refill, or discontinue medication therapy under approved collaborative practice agreements
• Order laboratory tests under approved collaborative practice agreements
• Work as an active member of the multidisciplinary care team
• Collaborate with providers and clinical staff to meet patient care needs
• Identify high-risk patients and implement interventions to improve quality and safety
• Provide medication counseling, education, and care coordination to patients and caregivers
• Develop and maintain collaborative practice agreements, clinical guidelines, treatment algorithms, and standardized workflows
• Support pharmaceutical care services that align with patient-care needs and regulatory standards
• Evaluate opportunities for operational, quality, and financial improvement
• Lead or participate in quality improvement initiatives and Medication Utilization Evaluations
• Develop and oversee policies and procedures related to service needs, drug distribution, drug control, and quality initiatives
• Participate in pharmacy operations and organizational clinical priorities
• Provide clinical education and drug information support to providers, pharmacists, residents, and other healthcare professionals
• Support clinical educational programs, competencies, and training experiences for pharmacy staff
• Serve as a preceptor and educator for pharmacy students and pharmacy residents, as applicable
• Maintain compliance with applicable regulatory and accreditation requirements
• Perform additional duties that support the pharmacy department and patient-care experience.

Clinical Pharmacist Specialist

• Design and implement innovative pharmacy programs to manage traditional and specialty drug costs under both medical and pharmacy benefits
• Research and synthesize detailed clinical data related to pharmaceuticals
• Prepare and present therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee
• Serve as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions
• Prepare information for network physicians

Clinical Pharmacist, Pharmacy Strategy Team

• Ensure Patient Outreach Coordinators consistently communicate with patients compliantly and convey the culture of kindness and value of the hospital-based pharmacies
• Coach Patient Outreach Coordinators on calling best practices, conversational techniques including how to listen, understand, respond, and confirm patients’ concerns about their care, pharmacy needs, and socioeconomic situations
• Complete audits of team in DialPad, TelemetryRX application, Electronic Medical Records, and other required systems to ensure effective communications with patients, efficient workflow, and compliant conversations with potential patients of hospital partner pharmacies
• Work with a high sense of urgency to manage, monitor, and facilitate any issues and/or escalations related to Outreach Coordinators with hospital partners
• Establish efficient workflows between Patient Outreach Coordinators, Onboarding Specialists and liaison team via collaboration with clinical integration team, on site managers, and Patient Outreach Management
• Manage all aspects of ADP, PTO, and Time Reports for team members
• Provide front line supervision and ongoing coaching and performance management to Patient Outreach Coordinators
• Monitoring and acting all forms of communications between Patient Outreach and other clinical and operational teams as needed
• Manage Telemetry application, email, Microsoft teams communications up to company policy
• Work with on site management at hospital partners for any collaboration calls, such as quarterly calls, kick off calls, as needed calls
• Patient Outreach team meetings: creating agendas, running meeting, follow up
• Hospital Management meeting: calls with on site manager to review current status, identify areas for improvement, and areas of success
• Record keeping/notes of all collaboration calls and team meetings
• Providing guidance/assistance/troubleshooting in daily tasks for Patient Outreach team members as requested by Patient Outreach Coordinators and Onboarding Specialists
• Review and address any concerns with Patient Outreach team, and hospital partners as needed
• Provide insight to various teams across company for growth and development opportunities as needed
• Work with various teams for special projects
• Report on hiring needs based on implementation roll outs
• Assist in interviewing, and onboarding new Patient Outreach Coordinators and Onboarding Specialists including coordinating access requests and trainings
• Investigate research needed for data analytics team, contracting team as needed
• Report to Manager of Patient Outreach

Pharmacy Technician Outreach Supervisor

• Helping to manage and improve patient health through safe and appropriate dispensing
• Supporting the management, oversight, and operation of all aspects within your pharmacy
• Strengthening pharmacy performance measures through effective coaching
• Contributing to positive patient experiences by showing empathy and genuine care
• Proactively offering and delivering immunizations to keep patients healthy
• Supporting the effective management of pharmacy inventory

Staff Pharmacist, Part Time

• Respond to basic customer questions via telephone and written correspondence regarding pharmacy retail and mail order prescriptions
• Develop and maintain positive customer relations
• Interact with internal and external customers to provide claims, customer service, and/or membership support
• Complete necessary research to provide proactive, thorough solutions
• Display ownership of service requests ensuring high quality resolution and follow-thru
• Support and guide the customer with their personal options and decisions

Pharmacy Customer Associate II – BioPlus Specialty Pharmacy

• Train students in the knowledge and competencies required by the profession.
• Support the administration of a pharmacy’s operations.
• Prepare, compound, and dispense medications.

Pharmacy Technician, Adjunct Instructor

• Review/validate basic prescription drug refill requests and process according to OCH policies and procedures.
• Assists with preparing and dispensing medications & supplies.
• Assist with maintaining equipment through calibration, inspection, cleaning, testing, and informing supervisor of any defects.
• Collect & maintain basic patient information required to ensure accurate planning of needed materials/supplies, equipment, and prescriptions.
• Help ensure a positive patient experience through answering basic patient questions and responding to basic patient requests.
• Receives & verifies quantities of incoming supplies & materials.
• Stocks & stores new supplies & materials.
• Review expiration dates.
• Identifying shortages.
• Pick and pack materials & supplies.
• Create tickets.
• Tracking of inventory through accurate data entry into applicable system(s).
• Schedule routine patient deliveries.
• Clean & sanitize surfaces and laminar hood flows.
• Clean & organize supplies.

Clinical Pharmacy Technician I

• Use evidence-based medicine and clinical judgment to evaluate pharmacotherapy suitability for high-risk patients
• Execute clinical protocols as allowed per organization and state regulatory agencies
• Optimize drug coverage benefits for appropriate care and reduced costs
• Collaborate with healthcare professionals to optimize patient care
• Participate in high-risk rounds to discuss patient progress
• Document all activity within clinic EMR and other required systems
• Conduct in-service education sessions for healthcare staff

Senior Integrated Clinic Pharmacist

• 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
• When appropriate, makes suitable recommendations for modifications in the prescribed medication therapy
• Collects and organizes patient-specific information needed to prevent, detect, and resolve medication-related problems
• Completes nutritional assessment of patients and makes appropriate recommendation
• Modifies the pharmacy care plans for home care patients based on evaluation of monitoring data
• Provides medication-use education to Option Care staff and home care patients
• Prepares and dispenses medications using appropriate techniques and following Option Care policies and procedures
• Manages the use, maintenance, and troubleshooting of medication administration equipment

• Evaluating and managing the selection and utilization of pharmaceuticals
• Supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management
• Researches and synthesizes detailed clinical data related to pharmaceuticals
• Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee
• May review and approve or deny coverage for pharmaceuticals based on medical necessity criteria
• Coordinates with internal stakeholders or health plan medical directors as needed
• Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs
• Provides clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use

Prior Authorization Clinical Pharmacist

• Report to a Supervising, Specialty Operations Pharmacist
• Inbound/Outbound calls to members
• Review prescriptions for accuracy
• Check for drug-drug interactions
• Evaluate appropriateness of disease state, dosage, directions and therapy
• Utilize electronic resources and guidelines to assist in professional decision making
• Develop and implement comprehensive care plans
• Monitor patient progress through regular assessments
• Provide medication education

Senior Specialty Consultative Pharmacist

• Actively participates in system planning, design, building, validation, implementation, enhancement, and maintenance processes for the electronic health record systems (EHR), and adjunct systems.
• Collaborates with department, enterprise IT associates, and hospital clinicians in the design, implementation and updating of clinical pathways, EHR build for primary medication orders, and order sets, protocols, charge master, and rules.
• Participates in Health Informatics testing for implementation of system upgrades, enhancements and patches while minimizing impact on department workflow, quality and specified regulatory and business functions.
• Maintains current medication formulary within the pharmacy and Physician Order Entry EHR systems as well as medication dosing resources, quality, safety, finance (charge master) systems, and infusion pump libraries.
• Responsible for build, maintenance and testing of all pharmacy electronic and data systems, infusion pump medication libraries and associated technologies in conjunction with clinical and operations pharmacy associates and leaders.
• Serves as a liaison for billing related questions and claim investigation as well as assures appropriate charging as relates to medications ordered utilizing the EHR systems.
• Coordinates training and education for departmental associates regarding modifications and enhancements to the clinical order management in the EHR systems, electronic medication resources, automated dispensing devices, and infusion pump libraries.
• Precepts Post-graduate Pharmacy Residents as part of dedicated Clinical Informatics rotation.

Clinical Pharmacy Specialist – Informatics

• Determines suitability of patients for home care.
• Supervises monitors and evaluates the quality of patient care provided by pharmacy staff.
• Oversees daily activities regarding effective operations and communications.
• Oversees activities of the pharmacies in assigned locations.
• Schedules work activities of pharmacy staff.
• Develops and mentors staff through onboarding, communication, training, and performance management processes.
• Oversees product purchasing, inventory, budget, and equipment management.
• Assists SDO in preparing, securing approval for, and implementing operating and expenditure budgets.
• Evaluates and oversees the purchase, management, and security of medications and supplies.
• Provides support to sales professionals and general manager by educating on available services.
• Collects and organizes patient-specific information to prevent and resolve medication-related issues.
• Monitors clinical staff’s documentation for home care and ATS patients.
• Evaluates competency in pharmacokinetic principles.
• Coordinates and participates in on-call responsibilities of the pharmacy department.
• Manages the use of investigational drug products as per regulations.

Pharmacist jobs in Florida

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Payor Contract Manager – Infusion

Clinical Pharmacist

Clinical Audit Coordinator, Pharmacy

Lead Pharmacy Technician

Supervisor, Specialty Pharmacy Services

Clinical Support Coordinator

Pharmacy Technician – PACE

Clinical Pharmacist Specialist

Clinical Pharmacist, Pharmacy Strategy Team

Pharmacy Technician Outreach Supervisor

Staff Pharmacist, Part Time

Pharmacy Customer Associate II – BioPlus Specialty Pharmacy

Pharmacy Technician, Adjunct Instructor

Clinical Pharmacy Technician I

Senior Integrated Clinic Pharmacist

Clinical Pharmacist

Prior Authorization Clinical Pharmacist

Senior Specialty Consultative Pharmacist

Clinical Pharmacy Specialist – Informatics

Director of Pharmacy