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

• Perform care management activities for members with complex and chronic care needs
• Ensure high quality, cost-effective care and appropriateness of treatment
• Partner with physicians and/or pharmacists to interpret appropriateness of care
• Collaborate with providers to assess consumer needs and plan for adverse events
• Conduct clinical assessments to develop individual care plans and goals
• Monitor and evaluate effectiveness of care management plans

Clinical Nurse Coordinator – Telephonic

• 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
• Assist the pharmacy team to ensure that pharmacy operations run smoothly
• Fill patients’ prescriptions promptly, safely, and accurately
• Deliver caring service that exceeds patient expectations
• Operate through consistent application of Standard Operating Procedures (SOPs) and effective communication
• Complete a rigorous company training program and satisfy all registration, licensing, and certification requirements according to their State’s Board of Pharmacy guidelines
• Follow pharmacy workflow procedures for safe and accurate prescription fulfillment
• Complete basic inventory activities as permitted by law and directed by the pharmacy leadership team
• Deliver additional patient health care services where allowable by law and supported by required training and certification

Pharmacy Technician

• 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

• Account Inquiries & Claims Processing
• Assist TrueScripts' members with pharmacy claims processing and plan benefits
• Receive phone calls/emails from members, clients, pharmacies and/or physician offices
• Troubleshoot claim processing problems and/or inquiries in claims adjudication system
• Respond to website inquiries
• Become proficient in all aspects of claims adjudication system
• Communicate escalated member service concerns to manager
• Account Support QA testing for client transitions/changes
• Complete pharmacy contact sheet for fax notifications
• Claims Logging, Invoicing & Reporting
• Log Specialty Care, Brand Care, Paper Claims, and Fee for Prior Authorizations on SharePoint
• Log Specialty and Non-Specialty Prior Authorization approvals on SharePoint
• Prepare and send weekly/monthly invoices to the Accounting team
• Document actions and outcomes in the client database

Member Care Advocate – Pharmacy Technician

• 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

• 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

• The Intern - Unpaid performs duties in field of study or profession
• Performs varied activities and moderately complex administrative/operational/customer support assignments
• Performs computations
• Typically works on semi-routine assignments
• Acts as an apprentice while completing formal education or immediately following graduation
• Decisions are typically focused on interpretation of area/department policy and methods for completing assignments
• Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction
• Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion

Pharmacy Intern

• 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

• 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.

Oncology Clinical Pharmacy Specialist

• 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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