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

• Conduct thorough medication reviews for pediatric patients, ensuring appropriateness, safety, and efficacy
• Collaborate with healthcare providers to develop and implement comprehensive medication management plans for pediatric patients
• Provide remote consultations to caregivers to address medication-related concerns
• Educate pediatric patients and their caregivers on proper medication use, potential side effects, and the importance of adherence
• Work collaboratively with interdisciplinary healthcare teams to ensure seamless communication and coordination of care
• Maintain accurate, timely and up-to-date documentation of medication management interventions
• Stay abreast of the latest developments in pediatric pharmacotherapy through ongoing education and training
• Participate in quality improvement initiatives to enhance the overall effectiveness of medication management services

Pediatric Pharmacist – MD Licensure

• Monitor FDA-approvals, drug manufacturer pipelines, and assess drug utilization reports
• Develop and execute the organization's drug formulary
• Develop pharmacy utilization management policies
• Maintain compliance with federal, state, and other mandates
• Write drug monographs for committee review
• Develop and implement management programs including prior authorization, dose and duration edits, quantity limits, step-care edits, and others
• Provide guidance to more junior team members
• Participate in evaluating, implementing, and monitoring pharmacy benefit-focused federal and state legislation
• Develop, execute, and monitor pharmacy-specific strategic initiatives
• Present recommendations to leadership

Senior Pharmacist – Strategy

• Support the pharmacy team in delivering operational and service excellence
• Assist patients and customers to deliver an exceptional experience
• Ensure that pharmacy operations run smoothly
• Fill patients’ prescriptions promptly, safely, and accurately
• Complete basic inventory activities
• Provide caring service that exceeds patient expectations
• Follow all company SOPs at each workstation

Pharmacy Technician

• Manage real time insurance claims while providing customer service to clients
• Analyze and approve claims that need to be adjudicated
• Determine coverage and apply medical necessity guidelines
• Identify and clarify any discrepancies to complete the adjudication process
• Work in cohesion with the CIC Department, Prior Authorization, and Billing Departments
• Submit claims and add appropriate corrections
• Ensure accurate and timely processing of real time claims
• Work directly with third party payers for claim resolution
• Communicate with facilities on claim issues that will need attention by the facility
• Resolve any discrepancies and secure proper reimbursement
• Any other duties associated with adjudication
• Create Prior Authorizations and notify Authorization team
• Follow federal and state regulations
• Adhere to company policies and procedures
• Follow HIPPA guidelines and regulations

Pharmacy Adjudication Specialist

• 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

• support the pharmacy team in delivering operational and service excellence within your store
• assist the pharmacy team to ensure that pharmacy operations run smoothly
• contribute to positive patient experiences by showing empathy and genuine care
• complete basic inventory activities
• contribute to a high-performing team, embracing a growth mindset

• Serve as the clinical subject matter expert on the account team
• Provide clinical consulting services through analyzing drug utilization patterns and trends for Pharmacy Benefit Management (PBM) clients
• Leverage presentation skills by delivering quarterly and annual clinical insight reporting to customers
• Educate clients on CVS Health’s clinical programs and making strategic solution recommendations
• Update client-specific clinical benefit elections
• Maintain above average client satisfaction scores and contribute to account team’s ability to increase client revenue

Pharmacist – Clinical Advisor

• Coordinate with the EPCU Pharmacist or pharmacy technicians to support timely review of IP (Investigational Product) randomization schedules, dose preparation requirements, and other project-related work.
• Ensure sufficient inventory of test and reference products to support ongoing study execution.
• Store IP according to study protocols, EPCU SOPs, and applicable regulatory guidelines.
• Prepare, label, and dispense IP for dosing in strict compliance with protocols, randomization schedules, EPCU SOPs, and regulatory requirements.
• Ensure timely and accurate delivery or availability of IP for all dosing activities.
• Maintain accurate and complete documentation of IP receipt, preparation, dispensing, returns, and destruction or return to the Sponsor.
• Oversee proper storage, archiving, and maintenance of IP study documentation.
• Ensure that IP is securely stored in designated locked areas within the EPCU.
• Comply with EPCU SOPs, Good Clinical Practices (GCP), and Good Pharmacy Practices.
• Participate in project or client meetings to represent EPCU Pharmacy services, as applicable.
• Support sponsor monitoring visits related to IP accountability and documentation.
• Assist in maintaining and improving pharmacy workflows and operational processes.
• Participate in quality improvement initiatives within the EPCU.
• Perform other pharmacy-related duties as assigned.

Pharmacy Technician – Per Diem

• 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

Pediatric Pharmacist – MD Licensure

Senior Pharmacist – Strategy

Pharmacy Technician

Pharmacy Adjudication Specialist

Clinical Pharmacist – Medicare STARS

Pharmacy Technician

Pharmacist – Clinical Advisor

Pharmacy Technician – Per Diem

Prior Authorization Pharmacist

Prior Authorization Pharmacy Technician

Clinical Pharmacist