Pharmacist

• Reviews patient charts to verify most recent provider visits and ensure eligibility for refill under the EMRC collaborative practice agreement.
• Gathers and reviews relevant clinical information (e.g., labs, monitoring parameters, and medication history) to support refill requests.
• Prepares and documents refill authorization requests using pharmacy technology systems in accordance with state law, policies, and protocols.
• Ensures all required clinical criteria and documentation are complete prior to pharmacist review.
• Routes completed refill requests to the pharmacist for final verification and processing.
• Communicates with pharmacists and care team members regarding missing information, concerns, or clarification needs.
• Identifies potential safety concerns or gaps in care and escalates appropriately to the pharmacist.
• Maintains accurate and compliant documentation in the patient record.
• Works collaboratively as part of a large, remote team; demonstrates strong interpersonal skills, professionalism, and the ability to build positive working relationships across the care team.

Pharmacy Technician – Refill Authorization

• Assist pharmacists in preparing and distributing medications
• Maintain the drug inventory
• Maintain patient records
• Work only under the supervision of a registered pharmacist
• Present completed medications to the pharmacist for verification
• Routinely interact with patients to ensure quality service

Pharmacy Technician – Float

• Create and Maintain Clinical Criteria for applicable Utilization Management (UM) programs: Develop and maintain clinical criteria (access to Prime standard and BCBSNE specific versions); Develop and maintain criteria process flows; Develop and maintain physician fax forms and other modes of communication; Utilize predictive modeling tool to intervene with high-risk members for identified disease states; Provide clinical updates as necessary to internal staff and physician reviewers; Performs highly complex research, analysis and develops recommendations for UM programs & plan design changes.
• Responsible for Operational workflows and Completion of UM reviews: Clinical oversight of first level review process; Clinical review of utilization management reviews; Perform clinical support for Pharmacy Technician and other staff; Utilize reporting tools to create efficiencies by reviewing medical and pharmacy claims data; Support physician reviewers with information required to efficiently review non-approvable claims; Develop Decision Tree review process when applicable.
• Maintain URAC accreditation: Work with internal staff to ensure that URAC accreditation is maintained; The pharmacist will work within their scope of licensure and unless expressly allowed by state or federal law or regulation, are located in a state or territory of the United States when conducting drug utilization review. The clinical pharmacists may not conduct peer clinical review non-certifications for drug utilization management, if prohibited by state utilization management laws. The clinical pharmacists may not conduct peer clinical review non-certifications for drug utilization management if the requesting party specifically requests a clinical peer.
• Measure quality assurance reporting, turnaround time for urgent and non-urgent reviews and quantitative assessment of UM reviews by program.
• Support Medicare Advantage processes, outreach, presentations, and tasks that require clinical direction and support. This includes, but not limited to, clinical presentations to internal and external stakeholders, providers, provider offices, and other customers.

Clinical Pharmacist

• Lead the development, negotiation, and execution of pharmacy service contracts with employer groups, health systems, and PBMs.
• Conduct contract evaluations and ensure successful implementation and maintenance of contractual agreements.
• Develop pricing strategies and ensure alignment with organizational goals.
• Analyze and interpret financial and operational data to inform decision-making and contract performance.
• Collaborate cross-functionally with pharmacy operations, business development, and manufacturer relations to address contract-related challenges.
• Present findings, recommendations, and contract terms to senior management and key stakeholders.
• Ensure compliance with applicable regulations, company policies, and industry standards.
• Maintain accurate contract documentation and support audit processes as needed.

Pharmacy Contracting Executive – PBM, Pharmacy Services

• Support patients on anticoagulation therapy across Colorado and Montana
• Facilitate medication access by helping resolve barriers
• Collaborate with pharmacists and advanced practice providers to ensure safe and high-quality care
• Coordinate lab monitoring and assist with adherence to provider recommendations
• Manage applications for home monitoring devices and related services
• Perform clinic administrative tasks, including scheduling visits and handling phone calls

Pharmacy Technician – Anticoagulation

• Work in an innovative environment with cutting-edge technology.
• Responsibilities include identifying, selecting and verifying pharmaceutical products, expiration dates and lot numbers; labels and weighs medication for accuracy; prepares packages and distributes medications in a fast-paced production environment; replenishes automated counting machines in accordance with local, state, and federal laws.

Certified Pharmacy Technicians, Non-Certified Pharmacy Technicians

• Lead, coach, mentor, and develop a team of Pharmacy Executives to ensure consistent delivery of exceptional client experiences and achievement of organizational objectives.
• Develop and execute the strategic vision for the Pharmacy Commit programs, ensuring alignment with Vizient's pharmacy and enterprise objectives.
• Work with leadership and client management regarding any key account and renewal of key accounts their team manages.
• Establish and monitor KPIs related to client satisfaction, contract activation, utilization, retention, and financial performance.
• Serve as executive sponsor for key Pharmacy Commit members, supporting executive business reviews, renewals, escalations, and strategic planning.
• Identify opportunities to expand participation, increase contract utilization, develop new offerings, and improve overall member value.
• Accountable for achieving revenue, savings, participation, and growth goals.
• Monitor program financial performance and recommend strategies to improve value delivered to members and Vizient.
• Standardize operational processes, establish best practices, and lead continuous improvement initiatives across the Pharmacy Commit organization.
• Identify emerging pharmacy trends, market opportunities, and innovative service offerings that enhance member value and strengthen Vizient's market leadership.
• Lead cross-functional collaboration across Pharmacy Sourcing, Consulting, Contracting, Analytics, Legal, Operations, Client Management, and Sales to deliver integrated pharmacy solutions.
• Drive contract performance by improving activation, utilization, compliance, and member adoption of pharmacy solutions.
• Provide executive oversight for Statements of Work, participation agreements, renewals, and contractual relationships to ensure alignment with strategic business objectives.
• Provide ongoing coaching and developmental support to the pharmacy teams.
• Establish and maintain a best-in-class client experience through proactive engagement, executive partnership, issue resolution, and measurable value delivery.

Senior Director, Pharmacy Commit

• Provide leadership and strategic direction to the Pharmacy Commit member facilities, distribution partners, and suppliers in collaboration with Vizient leadership and staff.
• Lead value-based initiatives, performance improvement, and revenue enhancement programs.
• Leverage clinical expertise, contracting strategies, and data-driven insights to deliver measurable value while cultivating strong member and partner relationships.
• Demonstrate a collaborative, team-based approach and take accountability for advancing pharmacy program success across highly engaged health systems.
• Manage new opportunities across contracting, policy, and analytics services.
• Drive contract performance by improving activation, utilization, compliance, and member adoption of pharmacy solutions.
• Build and maintain relationships with stakeholders up to the VP level to align strategic and operational priorities.
• Establish and monitor KPIs related to client satisfaction, contract activation, utilization, retention, and financial performance.
• Serve key Pharmacy Commit members, supporting executive business reviews, renewals, escalations, and strategic planning.
• Conduct voice-of-customer sessions to gather insights and refine program offerings.
• Oversee cross-functional project execution to deliver value-driven contracts and market insights.
• Enhance tools and processes to improve contract visibility and utilization.
• Analyze stakeholder data to identify growth opportunities and deliver actionable insights.
• Forecast revenue, pursue organic growth opportunities, and support business development efforts.
• Develop and deliver training, presentations, and customized business reviews for stakeholders.
• Diagnose healthcare challenges and recommend scalable, innovative solutions.

Pharmacy Executive IV

• Assists the pharmacist in collecting clinical and other patient information and maintaining appropriate records as required by regulation and policy.
• Utilizes pharmacy technology effectively to prepare medication orders for dispensing, performs calculations as necessary, and compounds medications for accurate compounding as appropriate to practice site, in accordance with state law, policies, procedures, and protocols.
• Accurately fills and maintains medication supplies including verifying and monitoring controlled substance inventories to ensure security, accuracy, cost effectiveness, and 340B/Charging management as required to practice site.
• Communicates with caregivers regarding responsibilities, identified concerns, and participates in quality and patient safety initiatives.

Pharmacy Technician – Prior Authorization

• Coordinate and process medication refills, including data entry and claim adjudication
• Place outbound refill calls and assist patients through the refill request
• Respond to and resolve inbound patient and provider inquiries
• Clarify prescription orders with pharmacists or clinical staff
• Maintain and update patient and prescription data in software systems
• Spot trends, recommend improvements, and support process-improvement initiatives
• Partner with cross-functional teams to deliver a seamless patient experience
• Maintain confidentiality and uphold high-quality service standards

Pharmacy Technician, Refill Calls

• 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

• This position supports and promotes ICU Medical products and services through pre-sales activities, product presentations, product education, in-service training, problem solving and post sales ongoing customer satisfaction.
• Align with the Regional Sales Managers, Strategic Account Executives and integrate activities with the Infusion Systems team as well as peer-to-peer clinical relationships with ICU Medical customers.
• Responsibilities in supporting the Enterprise Sales Team (EST) in working with the largest national opportunities.
• Performance goals will be tied to annual ICU Medical device signing’s/revenue objective for the specific coverage this role is aligned with.
• Liaise with Marketing, Quality, Operations and Manufacturing regarding complaints, problems, new products and revisions as well as special projects or issues.

Enterprise Pharmacy Manager – Infusion Systems

• Provides coordination and leadership for workflows and process improvement within a specialized operational area that spans multiple ministries.
• Performs daily services and functions of the specialized role at multiple ministries or in a centralized service model.
• Interacts in a matrix manner that includes learning multiple workflows for various sites, travel, managing matrix relationships and collaborating across team members and ministries to prioritize and efficiently complete work.
• Solves issues in the specialized area as they arise.
• Ensures documents and records are accurate and completed in a timely manner.
• Serves as a resource in the specialized area for other regional, system, and/or external stakeholders.
• Solves complex problems that may impact more than one ministry and ensures that issues are escalated and closed as needed.
• Complies with legal, regulatory, and accreditation standards.
• Keeps current with changes in the specialized field and collaborates with department leadership to adopt best practices.
• Coaches team members across multiple ministries when practice standards are not upheld.
• Conducts reviews and audits of specialized area.
• Reports and monitors KPIs to ensure optimal performance.
• Identifies quality improvement opportunities based on specialized skill set to ensure safe, effective, and efficient services and patient care.
• Creates system standardization and leads implementation of operational changes and advancements.
• Participates in regional or system specialized work teams, committees, and councils.
• Collaborates with regional or system leaders to develop and coordinate team member education, training, orientation, and competency.
• Trains other team members in specialized area.
• Prepares and distributes work schedules and provides cross-coverage for specialty area, as assigned.
• Serves as the multi-ministry or regional liaison to regional or system pharmacy teams in specialty area.
• Collaborates with leadership to communicate changes in specialty area.
• Provides excellent customer service to patients, other staff and ancillary departments and maintains high standards of confidentiality in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

Pharmacy Technician Coordinator

• Provide leadership and strategic direction to the Pharmacy Aggregation Group member facilities, distribution partners, and suppliers in collaboration with Vizient leadership and staff.
• Lead value-based initiatives, performance improvement, and revenue enhancement programs.
• Leverage clinical expertise, contracting strategies, and data-driven insights to deliver measurable value while cultivating strong member and partner relationships.
• Demonstrate a collaborative, team-based approach and take accountability for advancing pharmacy program success across highly engaged health systems.
• Manage new opportunities across contracting, compliance, policy, and analytics services.
• Build and maintain relationships with stakeholders up to the VP level to align on strategic and operational priorities.
• Conduct voice-of-customer sessions to gather insights and refine program offerings.
• Oversee cross-functional project execution to deliver value-driven contracts and market insights.
• Enhance tools and processes to improve contract visibility and utilization.
• Analyze stakeholder data to identify growth opportunities and deliver actionable insights.
• Forecast revenue, pursue organic growth opportunities, and support business development efforts.
• Develop and deliver training, presentations, and customized business reviews for stakeholders.
• Diagnose healthcare challenges and recommend scalable, innovative solutions.

Pharmacy Executive III

• Serve as the primary coordinator for patient cases
• Ensure smooth progression from referral through therapy completion
• Support specialty pharmacy operations by completing prior authorization documentation, scheduling medication deliveries, and facilitating document retrieval
• Provide exceptional customer service in a phone-based environment
• Perform claim adjudication tasks including prior authorizations, billing, and eligibility checks
• Collaborate with pharmacists, technicians, and healthcare professionals
• Conduct welcome calls and outreach to help new patients successfully onboard
• Maintain accurate, organized patient records from initial contact through benefit verification, therapy initiation, follow-up, and case closure
• Use multiple software platforms to manage authorizations, medication profiles, and patient communication
• Assist with patient questions and serve as backup during high-volume periods

Patient Care Coordinator, Specialty Pharmacy

• Responsible for managing the selection and utilization of pharmaceuticals
• Supports core clinical programs such as DUR, DIS, and formulary management
• Researches and synthesizes detailed clinical data related to pharmaceuticals
• Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee
• May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed
• Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs
• Provides dosage conversion and clinical support for therapeutic interventions
• Prepares information for network physicians

Clinical Pharmacist – Analytics

• support the pharmacy team in delivering operational and service excellence
• assist patients and customers to deliver an exceptional experience
• ensure pharmacy operations run smoothly
• complete basic inventory activities as directed

Pharmacy Technician

• Partners with Pharmacy executive team to drive business strategy and business development through insights and analysis
• Overall responsibility for Pharmacy program design, development, execution and performance
• Market surveillance, understanding of market demands and client pain points to ensure robust and competitive offering of Pharmacy programs, services, and solutions
• Provides analysis of financial performance, pharmacy business growth forecasts, business pipeline projections, and new solution value modeling
• Partners with VP of Growth, State Sector Leaders, and Account General Managers for analysis of bid pipeline and development of state strategies
• Supports state needs through RFP and bid proposals in support of the Pharmacy Center of Excellence organization
• Aligns proposal requirements to business execution plans
• Manages and optimizes vendor contracts
• Drives key initiatives in support of strategy, pharmacy growth, and business development
• Reports status of key initiatives and aligns resources across the organization for delivery of key strategies
• Supports executive team in development of growth plans and market strategies
• Drives development of strategy materials and presentations
• Drives analysis in support of business development projects and senior leadership key initiatives
• Supports analysis for Pharmacy segment P&L management
• Supports Pharmacy executive team on Rx cost optimization strategies
• Delivers analysis and support for business cases for new investments
• Helps drive 3rd party business development
• Leads industry relations and partnerships in support of GainwellRx
• Serves as an industry expert on GainwellRx, interfacing with external clients, vendors, and business partners
• Collaborates across account teams, sales teams, product teams, and other shared service functions
• Drives new ideas, partners with states on new concepts, and works with teams to deliver models to support them

Director, Pharmacy Strategy

• Submit and manage prior authorization requests for medications only, as required by insurance carriers.
• Review physician medication orders, supporting clinical notes, and documentation to ensure prior authorization requests are complete and accurate.
• Track medication prior authorizations from submission through approval, denial, or request for additional information.
• Follow up with payers to ensure timely determinations and minimize delays in medication access.
• Coordinate prescription refills in collaboration with providers and pharmacies.
• Serve as the primary point of contact for pharmacies regarding medication-related questions, clarifications, and insurance requirements.
• Support enrollment and coordination of patient assistance programs for medications when applicable.
• Communicate with patients regarding medication-specific authorization requirements, timelines, approvals, denials, and next steps.
• Identify medication prior authorization denials and coordinate appeals when appropriate.
• Manage assigned work queues, tasks, and follow-ups to meet defined turnaround times.
• Maintain compliance with payer requirements, HIPAA, and organizational policies.

PSC, Medication Prior Authorization, Pharmacy

• Responsible for performing all tasks relative to in-house and external communications with TrueScripts members, doctor’s offices’ and pharmacies
• Responds to member and client inquiries
• Assists members with appropriate prescription benefits
• Problem solves any issues in claims system
• Provides administrative support to Member Care Leadership, Client Success & Executive teams

Pharmacist jobs in Montana

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