Pharmacist

• 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

Pharmacy Relations Specialist

• Develop and deliver clinical messages to physicians, members, clients, and consultants
• Manage prior authorization, high-cost cases, claims editing and clinical policy development
• Evaluate and summarize clinical literature as well as financial implications related to medication management options
• Ability to present deep clinical and cost effectiveness information as a peer-to-peer consult

Clinical Pharmacist – Utilization Management

• Complete Clinical Reviews and provide a determination of Medicare-Medicaid Coverage Determination/Redetermination
• Responsible for support and input to clinical programs
• Continually monitor the quality and efficiency of the Prior Authorization process
• Provide input to clinical content of new programs
• Complete all annual NCQA, Aetna required and Quarterly IRR training requirements
• Responsible for supporting / providing clinical expertise related to formulary decisions
• Assist Member Services and other internal customers in responding to pharmacy-related inquiries
• Maintain open lines of communication with other functional areas/departments
• Stay current with clinical literature and guidelines

Clinical Pharmacist – AMA Dual

• 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
• Assists 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

• Engage with patients to navigate complex healthcare world
• Help members get a fair price for high-cost medications
• Correspond with provider offices on patient medication inquiries

Member Appeal Coordinator

• Support company's non-dispensing pharmacy operations by providing clinical oversight.
• Ensure employer-supported cash-pay pharmacy model delivers accurate clinical review and maintains patient safety.
• Collaborate with Product, Operations, and Compliance teams to build scalable pharmacy workflows.
• Review and clinically validate prescription information for accuracy.
• Partner with Product to design automated criteria and compliant workflows.

Pharmacist-In-Charge

• 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

See all jobs on JobTailor

Senior Pharmacy Performance Specialist

Pharmacy Care Technician

Pharmacy Technician – Utilization Management

Director, PBM Pharmacy Network Contracting

Supervisor, Specialty Pharmacy Support Service

Clinical Pharmacist – Medicare STARS

Pharmacist II, Clinical Consultation

Pharmacist, Clinical Consultation

Pharmacy Relations Specialist

Clinical Pharmacist – Utilization Management

Clinical Pharmacist – AMA Dual

Pharmacy Relations Specialist

Member Appeal Coordinator

Pharmacist-In-Charge

Prior Authorization Pharmacist

Prior Authorization Pharmacy Technician

Pharmacy Technician – Prescription Routing, Claims Support