Pharmacist

• Provides patient care through the provision of direct operational and / or clinical patient services
• Ensures the safe and appropriate use of medications through the provision of drug information
• Confirms the appropriateness of drug therapy as it relates to the care of specific patient populations
• Oversees pharmacy support personnel; checks and verifies the accuracy of all tasks performed
• Completes lab reviews, pharmacy consults and provides clinical services
• Provides experiential education and training for pharmacy technicians, students and new team members

Pharmacist, PT

• 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

• Support the pharmacy team in delivering operational and service excellence within your store
• Ensure pharmacy operations run smoothly and prescriptions are filled promptly and accurately
• Demonstrate empathy and genuine care in patient interactions
• Complete basic inventory activities as directed by pharmacy leadership

Pharmacy Technician

• Provide drug education and counsels patients on appropriate drug use and recommend drug discontinuation when indicated
• Provide written education for patient drug education
• Provide education to pharmacy staff, students and other healthcare professionals
• Utilize pharmacokinetic and drug dosing protocols and provides pharmacokinetic consultation for agents requiring such monitoring
• Evaluate drug therapy orders for appropriateness of dosage, route, interval, schedule and duration throughout patient’s hospital course and provide drug therapy consultations
• Suggest appropriate therapeutic alternatives for non-formulary drugs
• Analyze patient parameters (weight, height, existing condition, and laboratory data) and recommends appropriate dosing
• Participate in patient care rounds to provide input into monitoring of drug therapy
• Report adverse drug reactions or medication errors
• Record recommendations, interventions or other appropriate activity in EPIC

Clinical Pharmacist

• 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

• Leads, oversees and ensures the successful delivery and management of projects/systems within scope, quality, schedule, and cost constraints.
• Collaborates with pharmacy executives and evaluates productivity, communication, and teamwork.
• Helps identify project/system strengths, weaknesses, opportunities, and risks.
• Ensure that the project/system results meet agreed upon business objectives.

Pharmacist - System Specialist

• Deliver compassionate care to patients every day
• Manage all assigned pharmacy workstations and tasks to support the team’s ability to fill patient prescriptions promptly, safely, and accurately
• Provide caring service that exceeds customer expectations
• Complete an extensive CVS Pharmacy Technician Training Program and satisfy all registration, licensing and certification requirements according to your State’s Board of Pharmacy guidelines
• Work in compliance with federal, state, and local laws and regulations, ensuring all medication needs are met and regulatory compliance standards are upheld
• Demonstrate ethical conduct and maintain patient confidentiality at all times

• 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 promptly and accurately
• Complete basic inventory activities as permitted by law

• Support the pharmacy team in delivering operational and service excellence
• Assist the pharmacy team to ensure that pharmacy operations run smoothly
• Operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs)
• Contribute to positive patient experiences by showing empathy and genuine care
• Complete basic inventory activities, as permitted by law
• Remain flexible for both scheduling and business needs
• Understanding and complying with all relevant federal, state, and local laws, regulations
• Deliver additional patient health care services where allowable by law

• Responsible for support and input to clinical programs such as: Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place
• Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process by reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administration
• Continually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers
• Provide input to clinical content of new programs and for maintenance of existing programs
• Complete all annual URAC training requirements
• Facilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectives
• Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care
• Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee
• May review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; aid in documentation of calls; designate enrollees for repeat interaction
• Other duties as assigned

Pharmacist I – Clinical Prior Authorization

• Utilizing data insights, identify prescriptions that are delayed or stalled and take appropriate action.
• Establish, develop, and maintain working relationships with regional network specialty pharmacies, their leadership, and staff.
• Inform pharmacists and their staff on patient access and affordability programs that could be beneficial to patients.
• Work with HCPs to support complete, accurate and timely prescription submissions to Network specialty pharmacies or health plans, to minimize delay in therapy.
• Serve as a Network Specialty Pharmacy partner within assigned geography and communicate with stakeholders in a timely manner.
• Maintain a strong working relationship with sales and sales leadership.
• Assist the Field Reimbursement and Patient Services Team in identifying opportunities for continuous process improvements through root cause analysis and identifying ongoing training needs.
• Conduct needs assessment and provides appropriate education for HCPs (i.e., CoverMyMeds, Prior Authorization (PA) process, pharmacy process).
• Coordinate cases with patient support service program representatives (HUB) to ensure patient and physician needs are being addressed in a timely manner.
• Educate physician office staff on the use of patient assistance programs and call center support services, including web-based provider programs.
• Attend POAs and Regional conference calls, providing education, training, and feedback on the positioning of our network pharmacies and the current market access environment, to ensure a clear path for HCP and the patient.
• Provide timely information on patient access to the National Account Directors so they are informed and up to date on pharmacy claims and PA process for PBMs and payers.
• Collaborate with the Field Reimbursement and Patient Services Team on patient cases that need additional support and training activities with network pharmacies.
• Maintain the highest level of ethical obligations and ensure that all activities are complied with applicable laws and regulations.
• When called on for business travel manage personal travel schedule and travel arrangements.
• Prepare and submit appropriate expense reports in a timely fashion.

Pharmacy Experience Associate

• 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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