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

• Support the pharmacy team in delivering operational and service excellence within your store
• Assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately
• Show empathy and genuine care, creating heartfelt and personalized moments while serving patients
• Complete basic inventory activities, such as accurately putting away medication deliveries and completing cycle counts
• Contribute to a high-performing team, embracing a growth mindset, and being receptive to feedback
• Deliver additional patient health care services (e.g., immunizations, point-of-care testing, and voluntarily staffing offsite clinics)

Pharmacy Technician

• Review medication lists to eliminate barriers to therapy
• Contact pharmacies for medication refills
• Document care and communicate with providers
• Facilitate access to medications for financially challenged members

Clinical Pharmacy Technician

• Manage real time insurance claims while providing customer service to clients
• Analyze and approve claims that need to be adjudicated
• Determine coverage and apply medical necessity guidelines
• Identify and clarify any discrepancies to complete the adjudication process
• Work in cohesion with the CIC Department, Prior Authorization, and Billing Departments
• Submit claims and add appropriate corrections
• Ensure accurate and timely processing of real time claims
• Work directly with third party payers for claim resolution
• Communicate with facilities on claim issues that will need attention by the facility
• Resolve any discrepancies and secure proper reimbursement
• Any other duties associated with adjudication
• Create Prior Authorizations and notify Authorization team
• Follow federal and state regulations
• Adhere to company policies and procedures
• Follow HIPPA guidelines and regulations

Pharmacy Adjudication Specialist

• 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

• Support initiatives to resolve gaps in care through direct provider and member outreach
• Ensure that all recommendations are consistent with the latest guidelines or otherwise supported by the clinical compendia
• Provide clinical pharmacy support to pharmacy technicians as they conduct outreaches to members regarding med adherence
• Collaborate internally with Marketing, IT, and Enterprise Analytics to assist with the creation of strategic digital communication channels for member outreach
• Identify and resolve same-day grievances reported by members in a timely manner

Clinical Pharmacist, MTM

• Support pharmacy team in delivering operational and service excellence
• Assist pharmacy team to ensure that pharmacy operations run smoothly
• Demonstrate genuine care and contribute to a safe and inclusive culture
• Complete a rigorous company training program and satisfy all registration, licensing, and certification requirements

• Understand and adhere to the National EMR Policies and Procedures Manual, Uniform Handbook, and Operations Manual.
• Foster a culture that encourages team members to work safely, identify potential hazards, and report safety concerns immediately to their direct chain of command.
• Maintain active status within the agency’s platforms, including learning management systems to complete training that may be directed toward self-improvement, mission-specifics, or Just-In-Time (JIT) training.
• Execute assigned pharmacy services for the service population as prescribed by an advanced practice provider or physician and apply best practice guidelines to include but not limited to medication inventory, storage, distribution, and documentation.
• Communicate effectively with health care providers regarding care for service population and be a liaison between pharmacy and medical staff.
• Maintain adequate inventory of all medications/supplies, ensure medications/supplies are within date and properly stored.
• Dispose of all unused and expired medications properly according to established protocols.
• Maintain electronic/paper medical health care records as determined by event/deployment.
• Develop and maintain an accurate medication administration record (MAR) for each client.
• Assist in daily MAR audits, ensuring proper documentation. Reporting all medication errors utilizing chain of command.
• Compile daily medical lists and distribute to all designated staff.
• Maintain first aid kits per licensing standards, if applicable.
• Assist in medication intake/discharge process in collaboration with other medical staff.
• Other duties as assigned.

• 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

• Optimize patient outcomes through telephonic interventions
• Focus on the tactical execution of medication management services, including polypharmacy, adherence, and pharmacotherapy optimization
• Counsel patients via telephonic outreach on medication adherence, address any medication related problems such as adherence barriers, polypharmacy, or high risk medication use, and make appropriate evidence-based recommendations to patients and Practice Care Teams
• Perform focused clinical chart reviews as needed to inform patient interventions
• Obtain and document patient commitment to medication adherence and address barriers in real time
• Escalate complex clinical cases to prescribers or interdisciplinary teams as appropriate
• Meet and sustain performance goals (e.g., STARs, HEDIS)
• Collaborate with Physicians, clinical and administrative staff to optimize the Medication Management workflow and patient experience
• Proactively identify gaps in medication management through patient interactions and translate patient insights into targeted recommendations that drive improvements in practice operations and clinical workflows
• Participate in the design, implementation, and evaluation of pilot programs or process changes (“test and learn”) within the outreach model
• Serve as a clinical subject matter expert, leveraging clinical pharmacy expertise to support organizational objectives and adapt to evolving healthcare needs
• Develop and maintain standardized resources, educational tools, and clinical protocols to support improved medication outcomes and performance on quality measures (e.g., STARS, HEDIS) for practices, clinicians, and patients

Clinical Pharmacist, Pharmacy Outreach

• 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

See all jobs on JobTailor

Senior Pharmacy Performance Specialist

Pharmacy Technician

Clinical Pharmacy Technician

Pharmacy Adjudication Specialist

Clinical Pharmacist – Medicare STARS

Clinical Pharmacist, MTM

Pharmacy Technician

Pharmacy Technician

Pharmacist I – Clinical Prior Authorization

Clinical Pharmacist, Pharmacy Outreach

Pharmacy Technician – Prescription Routing, Claims Support