Pharmacist

• Lead end-to-end pharmacy testing across SIT, UAT, Regression, Parallel Testing, and Production Validation to ensure quality delivery of PBM and Medicaid pharmacy solutions.
• Develop and manage test strategy, plans, schedules, and execution governance, ensuring alignment with business requirements, CMS guidelines, and state Medicaid regulations.
• Oversee pharmacy functional validation, including claims adjudication, drug pricing, formulary management, prior authorization, rebates, NCPDP transactions, and financial reconciliation processes.
• Manage defects and cross-functional coordination among business SMEs, vendors, developers, conversion teams, and testing resources to ensure timely issue resolution and testing readiness.
• Provide leadership reporting and stakeholder communication by tracking quality metrics, risks, issues, and test progress.

Pharmacy Test Manager

• Responsible for driving growth in Specialty by building innovative products
• Develop robust product roadmap based on current and anticipated market trends
• Collaborate across the organization to deliver new solutions to market
• Build and execute product roadmap that solves payor, provider and patient needs
• Leverage pharmacist expertise to inform clinical strategy and performance
• Assist in the development of tools and processes to improve effectiveness
• Collaborate with external partners to develop strategies for managing high-cost medical drugs

Senior Manager – Oncology & Rare Disease Products

• Lead a team of engaged caregivers to provide the best possible experience for our customer and supplier stakeholders
• Own the operational performance metrics, internal improvement initiatives, and development of standards
• Effectively communicate with, coach, train, and develop the Category Management team
• Manage the daily managerial and strategic aspects of the Category Management teams with the greatest GPO portfolios
• Initiate continuous quality improvement by evaluating and enhancing operations
• Project management capabilities for high-visibility projects
• Responsible for both internal and external communications to maximize supplier awareness and utilization

Senior Director, Category Management – Pharmacy and Children’s Health

• leverage strong organizational and interpersonal skills to lead and manage a team focused on Specialty Generics optimization
• oversee Pharmacy Service Representatives (PSRs), Benefits Verification (BV) representatives, Work-in-Progress (WIP) representatives, and technicians to ensure efficient and compliant operations
• participate in the hiring process
• provide ongoing guidance, coaching, and direction to staff
• manage team schedules
• ensure adherence to standard operating procedures (SOPs)
• responsible for staff training and development
• problem-solving and follow-up
• performance monitoring and evaluation

Supervisor, Specialty Pharmacy Services

• Place outbound phone calls to members to offer Medication Therapy Management (MTM) services and other commercial programs outside of traditional MTM
• Provide outreach to members, prescribers, and pharmacy providers to enhance care coordination and support the Star ratings program
• Field inbound phone calls from members to initiate MTM or other CEC services
• Conduct telephonic comprehensive medication interviews and document medications as part of the MTM Program
• Facilitate communication to clients, providers, and internal staff regarding CEC programs and program outcomes
• Maintain knowledge of regulations regarding CEC programs
• Develop a full understanding of Navitus Clients’ member experience and how the CEC contributes to improved health and wellness
• Compliance with all applicable HIPAA and CMS regulations
• Other duties as assigned.

Telehealth Pharmacy Technician

• Lead negotiation of pharmacy participation agreements across all provider segments, including chains, grocers, PSAOs, and independent pharmacy networks.
• Own reimbursement structures, contract terms, and financial outcomes of pharmacy provider agreements.
• Establish negotiation strategies that balance market competitiveness with enterprise financial and network performance goals.
• Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions.
•Approve contract exceptions and ensure alignment to broader network strategy and pricing objectives.
• Provide strategic leadership over pharmacy participation agreements, network addenda, and contract standards, ensuring consistency with enterprise pricing, access, and compliance objectives.
• Develop and maintain contracting playbooks, standards, and governance frameworks to support scalable and consistent negotiation practices.
• Guide contract structure decisions to support evolving pricing strategies, regulatory changes, and market dynamics.
• Recommend enhancements to contract language and structure to improve clarity, enforceability, and long-term sustainability.
• Lead provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability.
• Serve as a senior point of contact for complex and strategic provider discussions, including reimbursement changes, contract interpretation, and structural alignment.
• Maintain strong relationships with key pharmacy partners to support transparency, issue prevention, and alignment on contract expectations.
• Drive resolution of high-impact or systemic provider issues, ensuring alignment to contract terms and enterprise objectives.
• Ensure negotiated contract terms are clearly defined, documented, and positioned for accurate downstream implementation.
• Partner with Network Operations and Performance teams to support effective handoff, implementation, and validation of contract terms.
• Provide strategic guidance on contract interpretation to support claims configuration, pricing application, and network governance.
• Support enterprise initiatives related to network strategy, growth, and regulatory readiness.
• Accountable for financial performance of pharmacy network contracts, ensuring negotiated reimbursement terms align with enterprise pricing strategy and expected outcomes.
• Partner with Network Performance and Reconciliation leadership to ensure contracted terms are operationalized and achieved through effective execution and monitoring.
• Incorporate performance insights and market feedback into future negotiation strategies and contract design decisions.
• Act as escalation point for complex, high-risk, or systemic contract issues requiring higher-level leadership intervention.
• Analyze trends in provider inquiries, disputes, and operational friction to identify opportunities for structural contract improvement.
• Drive continuous improvement initiatives to enhance contract clarity, reduce administrative burden, and improve provider experience.
• Provide leadership and direction to contract managers and/or senior contracting staff.
• Set expectations for negotiation discipline, contract quality, documentation, and escalation standards.
• Foster a high-performing team environment focused on accountability, consistency, and execution excellence.

Director, PBM PSAO/Indy Pharmacy Network Contracting

• Coordinate care between physicians, patients, and pharmacies
• Facilitate access to specialty medications for patients with complex disease states
• Review chart notes and perform utilization management on patient/drug specific case basis
• Handle case assignments, review case progress, properly document case notes, and determine case closure
• Provide clinical expertise to prescribers around preferred therapy
• Follow established procedures, processes, and standards for production, productivity, quality, and customer service
• Meet performance targets for speed, efficiency, and quality
• Ensure all external and internal customers receive the level of customer service required by Archimedes

Pharmacist, Utilization Case Manager

• Lead negotiation of specialty pharmacy participation agreements across all provider segments, including national chains with specialty capabilities, independent specialty pharmacies, and health system–affiliated providers.
• Own reimbursement structures, contract terms, and financial outcomes for specialty pharmacy agreements, including high-cost drug categories.
• Establish negotiation strategies that balance market competitiveness, provider sustainability, and enterprise financial objectives within the specialty drug landscape.
• Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions.
• Approve contract exceptions and ensure alignment to broader specialty network and enterprise strategy.
• Provide strategic leadership over specialty pharmacy participation agreements, network addenda, and contract standards, ensuring consistency with enterprise pricing, access, and compliance objectives.
• Develop and maintain contracting playbooks, standards, and governance frameworks to support scalable and consistent negotiation practices.
• Guide contract structure decisions to support evolving pricing strategies, regulatory changes, and market dynamics.
• Recommend enhancements to contract language and structure to improve clarity, enforceability, and long-term sustainability.
• Lead specialty provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability.

Director, PBM Specialty Pharmacy Network Contracting

• Acts as a liaison between Finance, Analytics, IT and Pharmacy
• Focus on understanding data content and the business logic behind all data transformation for reporting
• Develop expertise in the data and systems leveraged internally and externally for the Pharmacy Department
• Gather requirements, perform analysis, support the development and testing of processes
• Understand and document the applications, data and associated technologies for the Pharmacy Department

Senior Pharmacy Performance Specialist

• Assist in accurately reading, interpreting, and entering prescriptions into the computer system
• Calculate doses and assign directions
• Accept proper insurance payment in a timely fashion
• Route incomplete or unclear prescriptions to prescriber for clarification
• Enter incomplete prescription information once clarification is obtained
• Assist with inbound phone calls and interact with customers
• Cross-functional teamwork to answer questions, solve problems, and provide education
• Maintain company reputation for high-quality service
• New patient enrollment and verification of insurance coverage
• Perform benefit investigations and processing of medication orders for both new and existing patients.

Pharmacy Care Technician

• Develop and deliver follow up messages to physicians and members related to prior authorization and high cost case management case documentation
• Manage queues for pharmacy technician related work for prior authorization, high cost cases, claims editing and clinical policy processes
• Perform prior authorization case management related to administrative denial and low-clinical acuity cases as identified by clinical policies and guidelines.

Pharmacy Technician – Utilization Management

• Lead negotiation of pharmacy participation agreements across all provider segments, including national chains, grocers, PSAOs, and independent pharmacy networks.
• Own reimbursement structures, contract terms, and financial outcomes of pharmacy provider agreements.
• Establish negotiation strategies that balance market competitiveness with enterprise financial and network performance goals.
• Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions.
• Approve contract exceptions and ensure alignment to broader network strategy and pricing objectives.
• Provide strategic leadership over pharmacy participation agreements, network addenda, and contract standards, ensuring consistency with enterprise pricing, access, and compliance objectives.
• Develop and maintain contracting playbooks, standards, and governance frameworks to support scalable and consistent negotiation practices.
• Guide contract structure decisions to support evolving pricing strategies, regulatory changes, and market dynamics.
• Lead provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability.
• Ensure negotiated contract terms are clearly defined, documented, and positioned for accurate downstream implementation.
• Partner with Network Operations and Performance teams to support effective handoff, implementation, and validation of contract terms.
• Act as escalation point for complex, high-risk, or systemic contract issues requiring higher-level leadership intervention.

Director, PBM Pharmacy Network Contracting

• Schedule and monitor staff and day to day workflow.
• Develop employee’s skills, evaluate performance, and provide feedback.
• Oversees resolution of employee relations.
• Participate in hiring, training, and evaluation of staff
• Develop, track, and monitor employee’s compliance to quality, service, and production standards
• Monitor task turnaround time so that internal standards and client performance guarantees are met
• Assist Associate Manager, Pharmacy Services in monitoring costs to ensure compliance with cost goals
• Address staff concerns and day to day operational, system, customer service, quality, and professional issues
• Work in production as needed
• Implement programs and process improvements to enhance the level of internal and external customer service provided.
• Work with Associate Mgr., Pharmacy Services to analyze operations and overall efficiencies of the pharmacy
• Work as a point of escalation for issues requiring a higher degree of expertise or discretion to resolve.
• Represents pharmacy operations and service in cross-functional meeting and projects
• Participate in continued quality improvement and quality meetings as necessary
• Other duties as assigned

Supervisor, Specialty Pharmacy Support Service

• Demonstrates comprehensive knowledge of current pharmacotherapeutic principles, medical terminology, pathologies, disease state and population management, age appropriate therapy, and other information as related to medical and/or pharmaceutical care management.
• Work with Sentara Health Plan (SHP) members to close medication-related gaps in care
• Work on the referrals from the team
• Counseling members on their medication therapy

Clinical Pharmacist – Medicare STARS

• Provide patient education through telephonic consultations for patients of the specialty pharmacy in accordance with Lumicera’s Patient Management Program.
• Provide clear, detailed clinical documentation of patient consultations and interventions in pharmacy software in compliance with internal policies and procedures and external regulatory bodies (such as URAC) and EMR systems efficiently.
• Provide oversight of clinical outreach activities for specialty pharmacy patients. Including but not limited to, pharmacy transfers, prescription clarifications, and incomplete patient consultations.
• Interpret and clinically evaluate prescriptions for medications within all specialty disease states (including oncology) based on available information and resources.
• Contact providers and/or patients to verify information related to prescriptions such as drug strength, intended directions, and diagnosis to expedite processing of orders.
• Verify prescription information entered in the system by order entry. Answer clinical questions from the pharmacy team. Provide inter- and intra-departmental feedback and coaching on appropriate prescription entry and documentation as necessary.
• Document and report medication errors in accordance with company policies and manufacturer contracts. Facilitate error reduction and prevention methods based off quality department and ISMP standards. Adhere to all Lumicera pharmacovigilance standards.
• Act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve.
• Other duties as assigned

Pharmacist II, Clinical Consultation

• Perform telephonic consultations with patients regarding the use of their specialty medication and management of their disease state.
• Perform medication reconciliation, screen for potential drug interactions, and provide side effect management recommendations.
• Interpret physicians' prescriptions and contact prescribers for prescription clarification.
• Expedite the processing of orders and verify prescription information.
• Provide patient education through telephonic consultations in accordance with Lumicera’s Patient Management Program.
• Adapt to new workflows and processes, solve unique pharmaceutical problems, and stay current with advancements in specialty pharmacy therapies.
• Back up other pharmacists as needed and document medication errors per company policies and procedures.

Pharmacist, Clinical Consultation

• Make decisions regarding the resolution of pharmacy issues
• Establish and maintain contracts with pharmacy providers
• Facilitate submittal, receipt, tracking, and process flow of contracts between Navitus and providers
• Accurately enter information and maintain contract database
• Generate reports on network performance to monitor the claims accuracy throughout the terms of the contract
• Responsible for creating networks based on the contract terms within the claims processing system and ensure accuracy with performing quality reviews
• Assist in resolving intricate pharmacy provider issues and complaints
• Coordinate pharmacy network communication efforts including collection of content, disseminating information to provider partners through appropriate channels, and tracking response metrics
• Other duties as assigned

Pharmacist jobs in Idaho

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