Pharmacist

• Provide Comprehensive Medication Management (CMM) in collaboration with hub-based and virtual clinical care teams and provide other pharmacist support services as needed.
• Contribute in the development of a medication management action plan to achieve member self-management goals and clinical outcomes, with measurable parameters and timeline for monitoring and follow-up.
• Communicate and work collaboratively with Cityblock and external providers belonging to member care team to ensure all clinical interventions and encounters are aligned with medication-related goals, and conduct ongoing assessments and refinements to care plan necessary to promote goal attainment.
• Provide direct support to clinical team members for all general drug information, dosing, interaction/adverse effect avoidance questions or member-specific needs.
• Participate in staff education through presentation of medication management in-services, development of educational tools for clinical and non-clinical team members, and training/coaching/facilitating all roles on consistent maintenance of a member’s best possible medication list care management platform, Commons, as well as post-discharge med reconciliation process for providers.
• Help develop medication management and disease state-specific clinical pathways/protocols, with the eventual goal of transitioning to collaborative practice agreements (CPA) with Cityblock physicians, permitting pharmacist to perform member assessments, order laboratory tests, and initiate or adjust medications per protocol to improve the efficiency and effectiveness of team-based care.

Ambulatory Care Clinical Pharmacist – OH, MI, IL

• Support the pharmacy team in delivering operational and service excellence
• Assist patients and customers to deliver an exceptional experience
• Ensure pharmacy operations run smoothly and prescriptions are filled accurately
• Complete inventory activities and contribute to a high-performing team
• Comply with all relevant laws and regulations including those regarding patient safety

Pharmacy Technician

• Remote order entry and CPOE order evaluation and verification
• Assure acquisition or renewal of all pharmacy staff licenses
• Performs as staff pharmacist as needed
• Physician and nursing consultations
• Clinical medication dosing services
• Review and monitoring of profiles and lab values for therapeutic outcomes
• Coordinates access to medications according to facility policy and procedures, and in compliance with state and federal laws and regulations.

PRN Pharmacist

• Serve as an instructor and subject matter expert
• Offer specialized consultation to other business coaching team members
• Collaborate with assigned Business Coaching Coordinator
• Enhance customer retention and engagement
• Execute complex processes and engage in client-facing situations
• Continuously maintain and update coaching activities within the CRM system
• Compile pharmacy data to prepare necessary reports
• Drive results by aligning opportunities with customer needs
• Oversee all aspects of programs
• Identify potential weaknesses within pharmacy operations
• Work closely with Business Coaching Coordinator to assess customer needs
• Guide in-store implementations
• Develop and maintain a strong understanding of the independent retail pharmacy market
• Provide leadership with insights on industry intelligence
• Create and implement new concepts

Pharmacy Business Consultant

• 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 and prescriptions are filled accurately
• Complete basic inventory activities as directed

• Travel throughout your territory (approx. 80% travel, 50% overnight)
• Visit independent pharmacies regularly to grow sales and engagement
• Prospect for new business opportunities
• Build long-term relationships with pharmacy owners and staff
• Deliver business reviews and growth strategies in person
• Identify opportunities to increase participation and purchases
• Manage your territory pipeline and report results

Pharmacy Business Advisor

• 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

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Ambulatory Care Clinical Pharmacist – OH, MI, IL

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PRN Pharmacist

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Pharmacy Technician

Pharmacy Business Advisor

Prior Authorization Pharmacist

Prior Authorization Pharmacy Technician

Pharmacy Technician – Prescription Routing, Claims Support