UNKNOWN

ADAPTED_NOW

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.

YEAR

Become a part of our caring community and help us put health first The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. Location:Remote – United States Schedule: This is a VSP (Variable Service Provider) role. The hours will vary between 30-40 hours per week. You must be flexible to work: + 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST OR + 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST + Some weekend coverage may be required + Mandatory overtime during peak season Job Description: The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes. Use your skills to make an impact Required Qualifications: + Bachelor’s degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy + Active pharmacist license in the state of residence + Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid) + Self-directed with the ability to work effectively both independently and in a team environment + Strong problem-solving skills and the ability to foster collaborative solutions + High attention to detail with a strong work ethic focused on accuracy and productivity + Excellent verbal and written communication skills + Proficiency with computer systems, including but not limited to: + Microsoft Office Suite (Word, Excel, Outlook) + Clinical decision support tools (e.g., Micromedex, Lexicomp) + Pharmacy benefit management (PBM) platforms + Electronic health records (EHRs) + Passion for contributing to an organization focused on continuously improving the consumer experience Preferred Qualifications: + Experience in managed care pharmacy, particularly in utilization management review ​ Additional Information: Interview Format : As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. WAH Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Statement: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 1 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $94,900 - $130,500 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources

CenterWell

Staff Utilization Management Pharmacist (VSP/PT)

Humana

FEED

The jobs listed are examples of the typical kinds of positions that Costco may hire for when openings exist. The listing does not mean that any positions are currently open or available at Costco.

Overview:
California applicants: Please <a href="https://mobilecontent.costco.com/live/resource/img/static-us-landing-pages/CostcoCA-Job-Candidate-Privacy-Notice-2023.pdf" rel="noopener nofollow noreferrer" target="_blank">click here</a> to review the Costco Applicant Privacy Notice.  The jobs listed are examples of the typical kinds of positions that Costco may hire for when openings exist. The listing does not mean that any positions are currently open or available at Costco.  Position Summary: Dispenses prescription medications in high-volume pharmacy. For additional information about pay ranges, <a href="https://mobilecontent.costco.com/live/resource/img/static-us-landing-pages/Pay-Ranges-Cadient.pdf" rel="nofollow noopener noreferrer" target="_blank">click here.</a> We offer a comprehensive package of benefits including paid time off, health benefits (medical/dental/vision/hearing aid/pharmacy/behavioral health/employee assistance), health care reimbursement account, dependent care assistance plan, short-term disability and long-term disability insurance, AD&D insurance, life insurance, 401(k), and stock purchase plan to eligible employees.

Costco Wholesale Corporation

Pharmacist - Registered

[AW]-iCims

This includes Purchasing, Receiving, Auditing, Sterile and nonsterile compounding, Billing, Informatics, Medication Reconciliation, Licensing, Contracting, and Marketing. Pharmacy Technician (PHT), Pharmacy Intern (RPH-INT): Must have one of the following through the TX Board of Pharmacy: Pharmacy Tech (PHT).

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: + We serve faithfully by doing what's right with a joyful heart. + We never settle by constantly striving for better. + We are in it together by supporting one another and those we serve. + We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: + Immediate eligibility for health and welfare benefits + 401(k) savings plan with dollar-for-dollar match up to 5% + Tuition Reimbursement + PTO accrual beginning Day 1 _Note: Benefits may vary based upon position type and/or level._ Job Summary The Pharmacy Technician 3 leads in distributing medications and related tasks. They work independently and manage a specialized area while helping deliver pharmaceutical care. Essential Functions of the Role + Performs the duties of a lead pharmacy technician, mastery of all pharmacy technician duties and cross training new hires. + Maintains a specialized area of responsibility while aiding in care delivery. This includes Purchasing, Receiving, Auditing, Sterile and nonsterile compounding, Billing, Informatics, Medication Reconciliation, Licensing, Contracting, and Marketing. + Supports BSWQA clinical pharmacists by doing medication reconciliation and formulary research. Also supports the BSWQA Comprehensive Care Management Team. This team includes Registered Nurses, Social Workers, Community Health Workers, and Health Care Coordinators. Fields medication questions and escalates all clinical questions to the pharmacists. Attends CCM huddles and provides medication education topics for presentation by pharmacists or residents. + Performs advanced inventory management (i.e. ADM optimization, ADM build and rebuild). + Participates in education for pharmacy residents/students. + Completes prior authorizations (PA) for HTPN clinics (e.g. Hepatitis C medications, rifaximin, and PSCK9 inhibitors). + Completes renewal PAs for SPFS clinics. Verifies benefits and obtains financial help through manufacturer coupons, foundations, and patient assistance programs. Makes medication adherence calls. + Assists in coordinating and developing medication-related focus measure outreach workflows. Acts as the contact person for contracted payers regarding focus measures. + Reports outreach results back to payers and department managers. + Enhances performance on Medication Adherence Measures through patient engagement and education. + Coordinates the Drug Recall Process. Assists with special projects (workflows, training, events). + Filters/distributes at-risk lists from payers to appropriate parties. Key Success Factors + Professional understanding of Pharmacy Care modalities, terminology, pharmaceutical calculations, drug use and aseptic techniques, standards, and equipment. + Knowledge of procedures and standards for the labeling and dispensing of prescription medications. + Must be able to read, write and follow instructions and flow chart protocols. + Ability to sort, check, count, and verify numbers. + Ability to follow established safety, infection control, environmental and isolation practices and procedures at all times. + Interpersonal skills required to interact effectively with patients and staff. + General computer skills include using software applications, data entry, information security, electronic medical documentation, handheld scanning, and email. Belonging Statement We believe that all people should feel welcomed, valued and supported. QUALIFICATIONS + EDUCATION - H.S. Diploma/GED Equivalent + EXPERIENCE - 2 Years of Experience + CERTIFICATION/LICENSE/REGISTRATION - Pharmacy Technician (PHT), Pharmacy Intern (RPH-INT): Must have one of the following through the TX Board of Pharmacy: Pharmacy Tech (PHT) Pharmacy Intern (RPH-INT) Must also maintain PTCB/NHA certification OR possess associated skillset. As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!

Baylor Scott & White Health

Pharmacy Tech 3

Communicate effectively with physicians and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and timely manner. This role involves a high volume of daily contacts with members, physicians, and pharmacies to address medication-related issues, promote adherence, and ensure appropriate medication utilization.

Company : Highmark Inc. Job Description : JOB SUMMARY This is a call center outreach position. This job provides front line staff guidance and ensures effective and efficient delivery of pharmacy call center services. The Pharmacy Coordinator is responsible for supporting Highmark Wholecare’s pharmacy programs with a focus on medication adherence and optimizing member health outcomes. This role involves a high volume of daily contacts with members, physicians, and pharmacies to address medication-related issues, promote adherence, and ensure appropriate medication utilization. ESSENTIAL RESPONSIBILITIES + Communicate effectively with physicians and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and timely manner. + Interact with staff to implement processes and effectively solve problems. + Conduct outbound calls to members to discuss their medication regimens, identify barriers to adherence, and provide education and support. + Contact physicians and pharmacists to clarify prescriptions, obtain prior authorizations, and discuss alternative therapies to improve medication adherence and reduce costs. + Collaborate with internal teams, including pharmacists and case managers, to develop and implement strategies to improve medication adherence. + Document all interactions and interventions accurately and completely in the appropriate systems. + Monitor member medication adherence through claims data analysis and other available resources. + Identify and resolve medication-related problems, such as potential drug interactions, adverse effects, and therapeutic duplications. + Provide excellent customer service to members, physicians, and pharmacies. + Maintain current knowledge of pharmacy practices, medications, and relevant healthcare regulations. + Meet or exceed daily contact goals and quality standards. + Contact physician network providers to obtain necessary and/or additional information when necessary. + Consult clinical pharmacists for guidance and assistance as necessary. + Identify and report improper coordination of benefit billing practices through paid claims review. + Complete other assigned duties as specified. + QUALIFICATIONS Minimum + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment Preferred + Associate degree + Pharmacy technician certification certificate + Experience working in a managed care medication formulary management environment + Working knowledge of retail pharmacy and/or third party prescription procession + Strong background and understanding of medications and formulary terminology + Pharmacy technicians must be familiar with multiple Medicaid drug benefit design offerings and rules/regulations across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by state, while being familiar with applicable federal rules/regulations that remain consistent throughout the nation Skills + Excellent computer skills such as working knowledge of Microsoft Outlook, Word, OnBase + Excellent interpersonal, communication and attentive listening skills + Strong organizational skills, detail oriented + Demonstrated excellence in communication skills + Demonstrated ability to work well with others + Demonstrated ability to work in a fast paced, multi-task environment SCOPE OF RESPONSIBILITY Does this role supervise/manage other employees? No WORK ENVIRONMENT Is Travel Required? No _Disclaimer:_ _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ _Compliance Requirement:_ _This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies_ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ Pay Range Minimum: $19.27 Pay Range Maximum: $26.88 _Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J267462

Highmark Health

Pharmacy Coordinator Senior

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Staff Utilization Management Pharmacist (VSP/PT)CenterWell

Pharmacist - RegisteredCostco Wholesale Corporation

Pharmacy Tech 3Baylor Scott & White Health

Pharmacy Coordinator SeniorHighmark Health

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