Qureos Mentor

Cambia Health Solutions

<div><p><b>Pharmacy Operations Program Manager or Sr DOE
</b></p><p><b>Hybrid within Oregon, Washington, Idaho or Utah
</b></p><p></p><p><b>Build a career with purpose. Join our </b><b>Cause </b><b>to create a person-focused and economically sustainable health care system.
</b></p><p></p><div><p><b>Who We Are Looking For:
</b></p><p></p><p>Every day, Cambia's dedicated team of Pharmacy Operations Program Managers are living our mission to make health care easier and lives better. As a member of the Pharmacy Services Operations team, our Pharmacy Operations Program Managers oversee complex pharmacy benefit programs, manage vendor relationships, and drive operational excellence &ndash; all in service of creating a person-focused health care experience.
</p><p></p><p>Do you thrive on managing complex programs from implementation through optimization? Are you energized by collaborating across teams to solve challenges and drive continuous improvement? Then this role may be the perfect fit.
</p><p></p><div><p><b>What You Bring to Cambia:
</b></p></div><p></p><div><p><b>Qualifications:
</b></p></div><p></p><div><ul><li><p>Bachelor's degree in business, health administration, or related field and 5+ years of progressive experience in operational/business management, project/program management in healthcare, healthcare insurance operations or other large complex industries, and/or vendor management, or equivalent combination of education and experience
</p></li><li><p>Project Management Professional (PMP) certification or equivalent work experience preferred
</p></li><li><p>Experience managing end-to-end projects/programs including implementation in a healthcare setting and working with third-party service providers
</p></li></ul></div><p></p><div><p><b>Skills and Attributes:
</b></p></div><p></p><div><ul><li><p>Deep knowledge of pharmacy benefits, insurance operations, and healthcare delivery systems
</p></li><li><p>Strong analytical capabilities with ability to perform data-driven analysis of business opportunities and surface actionable insights
</p></li><li><p>Proven ability to develop and maintain vendor performance management strategies including scorecarding, SLA monitoring, and business reviews
</p></li><li><p>Expertise in project planning, scope management, resource allocation, risk mitigation, and cost management
</p></li><li><p>Skilled at establishing monitoring and control procedures for program assessment and continuous improvement
</p></li><li><p>Excellent stakeholder management with ability to build collaborative relationships across all organizational levels
</p></li><li><p>Strong presentation skills with ability to communicate complex information to leadership, project teams, and client groups
</p></li><li><p>Proactive problem-solver who independently identifies opportunities, gaps, and process improvements
</p></li><li><p>Ability to escalate and resolve issues effectively, ensuring timely problem resolution
</p></li><li><p>Experience facilitating and leading cross-functional teams to address complex operational challenges
</p></li><li><p>Capable of mentoring colleagues and acting as a subject matter expert
</p></li><li><p>Commitment to establishing personal goals aligned with team mission and maintaining accountability
</p></li><li><p>Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
</p></li></ul></div><p></p><div><div><p><b>What You Will Do at Cambia:
</b></p></div><p></p><div><ul><li><p>Manage new and buy-up pharmacy benefit programs, collaborating with Rx Product, Rx Informatics, Clinical, GTM, and StratFi teams on strategic decisions, implementations, and program enhancements
</p></li><li><p>Develop and maintain comprehensive monitoring and assessment protocols in partnership with program leaders and cross-functional directors, recommending improvements as needed
</p></li><li><p>Define, collect, and analyze program metrics to ensure performance targets are met and deliver insights to appropriate leadership forums including Echo report-outs
</p></li><li><p>Oversee vendor relationships and performance management, including regular scorecarding, SLA monitoring, risk identification, and continuous improvement initiatives
</p></li><li><p>Work with Rx Informatics and configuration teams on metrics development, StratFi for pricing and revenue updates, Clinical for vendor-proposed drug list changes, and vendor dashboards
</p></li><li><p>Lead problem management resolution efforts, validate issue prioritization, engage appropriate teams, and escalate to management when necessary to ensure timely resolution
</p></li><li><p>Prepare and present operational plans, status reports, and program documents to organizational leadership, project teams, and stakeholders
</p></li><li><p>Educate and train leadership, colleagues, business associates, and stakeholders on new program elements, processes, and implementations
</p></li><li><p>Drive continuous improvement across all vendor oversight processes, evaluating program outcomes and implementing sustainable operational solutions
</p></li><li><p>Facilitate multiple interdependent projects, maintaining accountability for scope, schedule, budget, risk management, and successful delivery of quality outcomes
</p></li></ul><p></p><p>#LI-Hybrid
</p></div></div></div><p></p><p>The expected hiring range for a Pharmacy Operations Program Manager is $84,200 - $113,900 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10% . The current full salary range for this role is $79,000 - $129,000 .
</p><p></p><p>The expected hiring range for a Pharmacy Operations Program Manager Senior is $101,200 - $136,900 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15% . The current full salary range for this role is $95,000 - $155,000 .
</p><p></p><p><b>About Cambia
</b></p><p></p><p>Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
</p><p></p><p><b>Why Join the Cambia Team?
</b></p><p></p><p>At Cambia, you can:
</p><ul><li>Work alongside diverse teams building cutting-edge solutions to transform health care.
</li><li>Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
</li><li>Grow your career with a company committed to helping you succeed.
</li><li>Give back to your community by participating in Cambia-supported outreach programs.
</li><li>Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
</li></ul><p></p><p>We believe a career at Cambia is more than just a paycheck &ndash; and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
</p><p></p><p>In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
</p><p></p><ul><li>Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
</li><li>Annual employer contribution to a health savings account.
</li><li>Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
</li><li>Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
</li><li>Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
</li><li>Award-winning wellness programs that reward you for participation.
</li><li>Employee Assistance Fund for those in need.
</li><li>Commute and parking benefits.</li></ul><p></p><p><br>
</p><p></p><p>We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
</p><p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p>We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
</p><p></p><p>If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy .</p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>

Pharmacy Operations Program Manager or Sr DOE

<div><p><b>Pharmacy Services Technician
</b></p><p><b>Work from home Within Oregon, Washington, Idaho or Utah
</b></p><p></p><p><b>Build a career with purpose. Join our </b><b>Cause </b><b>to create a person-focused and economically sustainable health care system.
</b></p><p></p><p><b>Who We Are Looking For:
</b></p><p></p><p>Every day, Cambia's dedicated Pharmacy Services Technician, are living our mission to make health care easier and lives better. As a member of the Pharmacy Operations team, our Pharmacy Services Technician is a corporate-wide technical support resource for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment. This function assists the Clinical Pharmacy Consultants and Pharmacy Services staff with formulary-related operations and other operational processes which require knowledge and experience with pharmaceuticals, all in service of creating a person-focused health care experience.
</p><p></p><p>Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
</p><p></p><p><b>What You Bring to Cambia:
</b></p><p></p><p><b>Qualifications:
</b></p><ul><li>High school diploma or related certificate required
</li><li>Three years of experience as a pharmacy services technician in a retail, hospital, or other licensed pharmacy setting, or equivalent combination of education and experience
</li><li>Pharmacy Technician certificate may be substituted for two years of experience
</li></ul><p></p><p><b>Skills and Attributes:
</b></p><ul><li>Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS, and HIPAA regulations, along with knowledge of pharmaceutical products including orals, injectables, infusion products, and chemotherapy
</li><li>Knowledge of general office practices and procedures with demonstrated knowledge of grammar and techniques of business practice
</li><li>Ability to interact effectively with a variety of health care professionals including physicians, nurses, pharmacists, and billing staff both internally and externally, while demonstrating maturity, tact, diplomacy, and persuasiveness
</li><li>Demonstrated ability to perform pharmaceutical dosing calculations and operate a variety of standard business machines including calculators and faxes
</li><li>Ability to type 30 words per minute (60 wpm preferred) with basic computer program skills including Word, Excel, and other standard applications
</li><li>Ability to organize, plan, and prioritize daily workflow and projects within time constraints; experience with health insurance and/or prescription benefits preferred
</li><li>Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
</li></ul><p></p><p><b>What You Will Do at Cambia:
</b></p><ul><li>Perform all duties as described unless clinical judgment is required, in which case seek assistance from appropriate medical personnel who will be available for support during normal business hours
</li><li>Respond to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, government programs personnel, and customer service regarding formulary drug coverage, appeal and reconsideration claim status
</li><li>Complete daily formulary operational processes including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals
</li><li>Prepare reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation including medical chart notes, reports, and medication profiles; communicate information and determinations to providers and members orally and through written documentation as necessary
</li><li>Obtain and organize drug utilization data including patient-specific and population-based data in a manner that facilitates clinical review and decisions by Clinical Pharmacist Consultants, including sorting drugs into appropriate therapeutic and generic categories
</li><li>Assist with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of resources, substance abuse, and erroneous and fraudulent billing practices; investigate and organize workflow for claims referred to Pharmacy Services for review and allowable determination including miscellaneous J codes, providers on review, and reconsiderations
</li><li>Support wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement; contribute to and support the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward quality improvement efforts
</li></ul><p></p><p><b>#LI &ndash; Remote
</b></p><p></p><p>The expected hiring range for a Pharmacy Services Technician is $20.50 - $30.80 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 5%. The current full hourly range for this role is $19.20 - $34.90 an hour.
</p><p></p><p><b>About Cambia
</b></p><p></p><p>Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
</p><p></p><p><b>Why Join the Cambia Team?
</b></p><p></p><p>At Cambia, you can:
</p><ul><li>Work alongside diverse teams building cutting-edge solutions to transform health care.
</li><li>Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
</li><li>Grow your career with a company committed to helping you succeed.
</li><li>Give back to your community by participating in Cambia-supported outreach programs.
</li><li>Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
</li></ul><p></p><p>We believe a career at Cambia is more than just a paycheck &ndash; and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
</p><p></p><p>In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
</p><p></p><ul><li>Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
</li><li>Annual employer contribution to a health savings account.
</li><li>Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
</li><li>Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
</li><li>Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
</li><li>Award-winning wellness programs that reward you for participation.
</li><li>Employee Assistance Fund for those in need.
</li><li>Commute and parking benefits.</li></ul><p></p><p><br>
</p><p></p><p>We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
</p><p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p>We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
</p><p></p><p>If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy .</p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>

Pharmacy Services Technician

<div><p><b>Pharmacy Services Technician
</b></p><p><b>Work from home Within Oregon, Washington, Idaho or Utah
</b></p><p></p><p><b>Build a career with purpose. Join our </b><b>Cause </b><b>to create a person-focused and economically sustainable health care system.
</b></p><p></p><p><b>Who We Are Looking For:
</b></p><p></p><p>Every day, Cambia's dedicated Pharmacy Services Technician, are living our mission to make health care easier and lives better. As a member of the Pharmacy Operations team, our Pharmacy Services Technician is a corporate-wide technical support resource for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment. This function assists the Clinical Pharmacy Consultants and Pharmacy Services staff with formulary-related operations and other operational processes which require knowledge and experience with pharmaceuticals, all-in service of creating a person-focused health care experience.
</p><p>Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
</p><p></p><p><b>What You Bring to Cambia:
</b></p><p></p><p><b>Qualifications:
</b></p><ul><li>High school diploma or related certificate and 5 years of experience as a pharmacy services technician in a retail, hospital, or other licensed pharmacy setting, or equivalent combination of education and experience
</li><li>Pharmacy Technician Certificate may substitute for 2 years of experience (reducing requirement to 3 years)
</li></ul><p></p><p><b>Skills and Attributes:
</b></p><ul><li>Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS, and HIPAA regulations
</li><li>Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy
</li><li>Knowledge of general office practices and procedures, and demonstrated knowledge of grammar and techniques of business practice
</li><li>Ability to interact effectively with a variety of health care professionals, including physicians, nurses, pharmacists, and billing staff both internally and externally, while demonstrating maturity, tact, diplomacy, and persuasiveness
</li><li>Demonstrated ability to perform pharmaceutical pricing calculations and ability to type 30 words per minute, 60 wpm preferred
</li><li>Demonstrated ability to operate a variety of standard business machines including calculators, copiers, and faxes, and basic computer program skills (Word, Excel, etc.)
</li><li>Ability to organize, plan, and prioritize daily workflow and projects within time constraints, and experience with health insurance and/or prescription benefits preferred
</li></ul><p></p><p><b>What You Will Do at Cambia:
</b></p><ul><li>Performs all duties as described unless clinical judgment is required, in which case the Pharmacy Services Technician will seek assistance from appropriate medical personnel who are available for support during normal business hours
</li><li>Responds to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, government programs personnel, and customer service, including formulary drug coverage, appeal and reconsideration claim status, and pricing for drug claims
</li><li>Completes daily formulary operational processes, including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals
</li><li>Prepares reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation, including but not limited to medical chart notes/reports and medication profiles, and communicates information and determinations to providers and members as necessary (orally and by written documentation)
</li><li>Obtains and organizes drug utilization data, including patient specific and population-based data, in a manner which facilitates clinical review and decisions by Clinical Pharmacist Consultants, including sorting drugs into appropriate therapeutic and generic categories
</li><li>Assists with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of resources, substance abuse, and erroneous and fraudulent billing practices, and investigates and organizes workflow for claims referred to Pharmacy Services for review and allowable determination (misc. J codes, providers on review, reconsiderations)
</li><li>Supports wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement, and contributes to the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward quality improvement efforts
</li></ul><p></p><p><b>#LI &ndash; Remote
</b></p><p></p><p>The expected hiring range for a Pharmacy Services Technician is $20.50 - $26.80 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 5%. The current full hourly range for this role is $19.20 - $34.90
</p><p></p><p><b>About Cambia
</b></p><p></p><p>Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
</p><p></p><p><b>Why Join the Cambia Team?
</b></p><p></p><p>At Cambia, you can:
</p><ul><li>Work alongside diverse teams building cutting-edge solutions to transform health care.
</li><li>Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
</li><li>Grow your career with a company committed to helping you succeed.
</li><li>Give back to your community by participating in Cambia-supported outreach programs.
</li><li>Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
</li></ul><p></p><p>We believe a career at Cambia is more than just a paycheck &ndash; and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
</p><p></p><p>In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
</p><p></p><ul><li>Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
</li><li>Annual employer contribution to a health savings account.
</li><li>Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
</li><li>Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
</li><li>Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
</li><li>Award-winning wellness programs that reward you for participation.
</li><li>Employee Assistance Fund for those in need.
</li><li>Commute and parking benefits.</li></ul><p></p><p><br>
</p><p></p><p>We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
</p><p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p>We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
</p><p></p><p>If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy .</p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>

Pharmacy Services (Digital Support) Technician

Join Cambia Health Solutions and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Cambia Health Solutions

About Company

Pharmacy Operations Program Manager or Sr DOE

Pharmacy Services Technician

Pharmacy Services (Digital Support) Technician