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

• 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

• 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

• 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

• Operate within pharmacist-led clinical programs focused on chronic disease, quality improvement, and medication optimization.
• Activate on provided lists of eligible patients by outreaching, enrolling, and engaging patients. Maintain engagement through education, outreach, and follow-up.
• Conduct Medication Reconciliation, Medication Therapy Management (MTM), and Comprehensive Medication Reviews (CMR).
• Provide telephonic patient education on medication use, adherence, self-management, and escalation of care.
• Provide specific actionable medication recommendations and collaborate with providers, using technology and direct communication, to support practice adoption and medication management.
• Support other clinical programs to provide periodic consultation on pharmacy related issues affecting patients
• Drive medication adherence to address quality gaps
• Collaborating with the IDT—which includes primary care physicians, health coaches, and nursing staff—to develop patient-specific clinical action plans, reconcile medications, and make necessary adjustments to medications.
• Accelerate adoption of clinical insights by providers by driving uptake of actionable drug-related recommendations.
• Provide clinical feedback to enhance decision support logic, usability, and impact.
• Collaborate with Regional Medical Officers, Market Medical Directors, Practice Transformation Managers, care teams, and practices.
• Support consistent clinical standards, workflows, and messaging across markets.
• Support ideation and development of initiatives related to specialty medications, high-cost drugs, and pharmacy optimization programs.
• Partner with pharmacy and medical leadership on drug strategy aligned with value-based care goals.
• Document all clinical activity accurately and in accordance with state and federal regulations and HIPAA requirements, using provided platforms and technologies
• Serve as a pharmacy information resource for providers and internal clinical teams.
• Remain current on clinical guidelines, quality measures, and pharmacy best practices.

See all jobs on JobTailor

Senior Pharmacy Performance Specialist

Patient Care Pharmacist – Short Term Assignment

Clinical Pharmacist – Medicare STARS

Prior Authorization Pharmacist

Prior Authorization Pharmacy Technician

Clinical Pharmacist