Pharmacist

• Provide comprehensive medication management, including reconciliation, dose optimization, adherence support, and drug-level assessments aligned with evidence-based standards.
• Partner with physicians, specialists, and interdisciplinary teams to order individualized care plans under a CPA and promote seamless medication coordination.
• Monitor therapy effectiveness and safety, identify optimization and intervene as appropriate.
• Support quality-improvement and REMS initiatives.
• Provide recommendations to operations by supporting teammates as needed with complex prior authorizations, improving workflows, educating patients, and maintaining ongoing clinical development.

Clinical Pharmacy Specialist, HIV

• 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

• Facilitate effective operational workflow while performing complete, accurate and consistent reviews of all formulary exception medication or product requests; including review of appropriate labs and supporting documentation against pharmacy clinical criteria/ guideline, which involves referral/escalation of requests, when appropriate, to clinical experts with appropriate recommendations.
• Utilize appropriate approval and denial language on approval and denial messages and provide alternatives based on clinical guidelines.
• Communication with facilities: Maintain on-going communication with facility teammates, resolve technical processing issues, and escalate all outstanding issues including drafting written responses, correspondence, emails, and spreadsheets as needed.
• Ensure that current and accurate communication with facility teammates occurs in a clear, timely and concise manner.
• Assist with special projects as assigned by Clinical Operations management or its partners

Authorization Coordinator I, Clinical Pharmacy Management

• Serve as a trusted advisor providing Pharmacy thought leadership for Employee Benefits at a regional level
• Drive sales and revenue growth by expanding current client relationships and new client opportunities in the mid and large employer market space through RFP participation, onsite or video presentation and one on one consultation
• Communicate strategic and tactical up-to-date pharmacy business initiatives and solutions in a way that allows clients to understand the impacts to their strategy and their employees
• Partner with, train and develop HUB financial consultants, producers and account management personnel to understand and present key Pharmacy findings and solutions
• Provide detailed pharmacy analysis(es) working with the HUB analytics platform along with various partners and PBM's decision support tools to justify the election of the appropriate pharmacy solution
• Provide proactive topical pharmacy communication(s) to HUB internal staff and external clients through a variety of methods including regional or local webinars and seminars
• Represent the National Pharmacy Practice in various strategic business initiatives as appropriate
• Contribute to National Pharmacy Practice team as a collaborative partner and subject matter expert
• Assist in the development of the Pharmacy "practice" and help to implement appropriate changes to our solutions and service(s) to improve client results

Pharmacy Consultant

• Work independently with all levels of Core Leaders
• Utilize advanced subject matter expertise in pharmacy and analytical skills
• Lead teams and design advance data sources
• Develop quality assurance processes and test multiple hypotheses
• Design challenging visualizations and use advanced contemporary data science techniques
• Provide ongoing training and facilitate multiple projects
• Manage clinical programs as assigned

Clinical Pharmacy Specialist

• 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

Clinical Pharmacy Specialist – Licensed

• Provide integrated support to patients and physicians by providing a "hands-on" approach to improve the quality of patient care.
• Review and interpret clinician's patient care note/assessments for supportive clinical data needed for prior authorization approvals.
• Develop and refine disease and drug specific clinical protocol to maximize patient adherence and promote evidence-based cost-effective care.
• Monitor ongoing patient adherence across all sites and disease categories.
• Evaluate EMR to review drug and disease interaction, medication selection, labs/vitals, allergies, RX orders/renewals.
• Recommend alternative therapeutic drug regimens according to guidelines as appropriate.
• Monitor and evaluate therapies for side effects or other medication related issues.
• Conduct medication therapy management (MTM).
• Perform clinical interventions including comprehensive pharmacist consultation, motivational interviewing/coaching, drug regimen optimization, medication reconciliation.
• Monitor productivity and report weekly stats for growth development.
• Oversee tech's daily activities and verification for accuracy on delivery coordination slips and prior authorizations submitted.
• Identify and resolve insurance related issues, recognizing situations for financial assistance.
• Supervise communication of support personnel compliant with HIPPA rules and regulations.
• Maintain current registration and all remote pharmacist activity according to regulations.
• Direct communication with other health professionals regarding patient care.

Clinical Pharmacist

• 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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