Qureos Mentor

NeighborHealth

<div><div>Thank you for your interest in a career at NeighborHealth, formerly East Boston Neighborhood Health Center!
As one of the largest community health centers in the country, NeighborHealth is proud to serve the greater Boston area with a strong commitment to the health and well-being of our patients and communities.</div><div>
Whether you're a nurse or physician providing direct care, a manager leading dedicated teams, or part of the essential support staff who keep our operations running smoothly &mdash; every role at NeighborHealth is vital. Together, we&rsquo;re advancing medicine and delivering the best care experience for our patients and community!</div><div><div><div>
Interested in this position? Apply online and create a personal candidate account!</div></div></div>
Current Employees of NeighborHealth- Please use our internal careers portal to apply for positions.
To learn more about working at NeighborHealth and our benefits, please visit out our Careers Page.
Time Type:
Full time
Department:
Pharmacy Administration
All Locations:
10 Gove Street &ndash; Taylor Building, 20 Maverick Square &ndash; Cradock Building, 300 Ocean Avenue &ndash; Revere
Position Summary:
Under the direct supervision of the Director of Pharmacy Infrastructure and Support Operations, and according to department policies, procedures, and guidelines, is responsible for procurement and disposition of all pharmacy-related departmental pharmaceuticals and maintenance of pharmacy medication and supply inventory to support the provision of cost-effective patient-focused pharmacy services. Ensure compliance with the Drug Supply Chain Security Act (DSCSA). Responsible for training and managing the daily activities of inventory specialist team members to keep pharmaceutical purchases and associated supply inventory within established target performance criteria. Supervises inventory specialist team and sets guidelines for store level pharmacists in the placement of orders, inventory &amp; fulfillment processes, including controlled substances. Oversees the quality and safety of packaging and storage of medications. Helps develop strategy and key performance goals for the department to improve costs, efficiency, patient care, and satisfaction. Performs various administrative projects as assigned relating to continuous quality improvement of the drug inventory purchasing process.<ul><li>
Establishes and monitors inventory and drug budgets for designated pharmacy. Provides analysis of budget variances and leads development of initiatives to control costs.</li><li>
Establishes key performance indicators that serve as a firm guide helping to keep the purchasing and inventory processes within set targets thereby ensuring budgetary agreement. Manages the day to day operations in real time, with a focus on the purchasing, receiving and inventory control processes.</li><li>
Supervises the inventory specialist team. Supervision includes training, delegating tasks, overseeing daily activities, mentoring, guiding through demonstration of best practices and offering opportunities for professional development.</li><li>
Oversees the training of pharmacy employees in stocking the pharmacy shelves appropriately, monitoring for outdated products, and the processing returns for prompt credits.</li><li>
Oversees the ordering and receiving of all drugs and supplies at all pharmacies in a timely manner.</li><li>
Oversees the return of identified eligible pharmaceuticals in a timely manner.</li><li>
Coordinates the procurement and maintenance of medication and non-drug supplies (labels, etc.) necessary for the fulfillment of patient prescriptions at all pharmacy locations.</li><li>
Ensures proper rotation and maintenance of inventory. Coordinates with the Return Company for quarterly removal of expired drugs.</li><li>
Coordinates the bi-annual pharmacy medication inventory for all outpatient pharmacies.</li><li>
Processes drug recalls in a timely manner when informed by the FDA and Drug Companies.</li><li>
Lead the management of short or long-term backorders or medication shortages.</li><li>
Maintains a timely and accurate flow of purchasing and receipts with Accounts Payable and resolve all billing problems. Provides oversight for the Accounts Payable process and holds others accountable for meeting expectations.</li><li>
Generates purchasing and inventory reports and analysis as requested by the Chief Pharmacy Officer or Director.</li><li>
Prepares, secures authorized signature, and processes all purchase orders; assists manager in establishing appropriate annual Purchase Orders for vendors.</li><li>
Monitors purchasing contract compliance and market share on a quarterly basis.</li><li>
Works with manager in the development and preparation of proposals to bid for pharmaceutical contracts; track credits and rebates due once the contracts are signed.</li><li>
Develops and oversees processes to make optimal use of the 340B drug program, including monitoring of purchases and identifying deviations from historical trends.</li><li>
Establishes best practices for product selection (e.g. best pricing, package size, etc.) to best suit the needs of the pharmacies.</li><li>
Manages preferred drug selection in the pharmacy management system by identifying drug records with multiple available generic options. Drive pharmacy team to select the preferred drug option through management of the inventory with the pharmacy management system.</li><li>
Manages the pharmacy department temperature monitoring program, including the electronic monitoring system.</li><li>
Oversees and complies with the Drug Supply Chain Security Act (DSCSA) requirements.</li></ul>
EDUCATION:
<ul><li>Bachelor&rsquo;s Degree required</li></ul>
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
<ul><li>Registered Technician with the Massachusetts Board of Pharmacy required</li><li>
Nationally Certified Pharmacy Technician required</li><li>
340B Apexus Certified Expert (ACE) preferred</li><li>
Supply Chain and Inventory Management Advanced Certificate preferred</li></ul>
EXPERIENCE:<ul><li>
Requires at least five years of pharmacy-related experience, including drug purchasing and inventory management.</li><li>
3 years of management experience or leading teams</li></ul>
SKILLS/ABILITIES:<ul><li>
Requires mathematical skills, knowledge of purchasing, and material management.</li><li>
Strong analytical and problem-solving ability.</li><li>
Effective interpersonal skills to interact appropriately with staff, patients, families/visitors, physicians, colleagues, and others.</li><li>
Ability to multitask, prioritize essential tasks, and meet deadlines.</li><li>
Leadership ability to guide, direct, and mentor staff.</li><li>
Experience with Microsoft programs (i.e. MS Word, Excel, Outlook) and web browsers. Experience with Pharmacy Management software or the ability to learn is required.</li><li>
Must possess self-management skills and require little to no supervision. This person must be a self-starter, self-motivating, have a strong work ethic, and must have the ability to identify issues or opportunities that require attention and change.</li><li>
Must possess and exhibit process improvement skills and acumen.</li></ul>
Salary starts at $99,840, and up to $153,920.00 based on years of experience.
EEO &amp; Accommodation Statement:
NeighborHealth is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to HRrecruit@NeighborHealth.com or call 617-568-4480 to let us know the nature of your request
Federal Trade Commission Statement: 
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website. We do not ask or require downloads of any applications, or &ldquo;apps.&rdquo; Job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
E-Verify Program Participation Statement:
NeighborHealth participates in the Electronic Employment Verification Program, E-Verify. As an E-Verify employer, all prospective employees must complete a background check before beginning employment.</div>

Manager, Pharmacy Purchasing Operations

<div><div>Thank you for your interest in a career at NeighborHealth, formerly East Boston Neighborhood Health Center!
As one of the largest community health centers in the country, NeighborHealth is proud to serve the greater Boston area with a strong commitment to the health and well-being of our patients and communities.</div><div>
Whether you're a nurse or physician providing direct care, a manager leading dedicated teams, or part of the essential support staff who keep our operations running smoothly &mdash; every role at NeighborHealth is vital. Together, we&rsquo;re advancing medicine and delivering the best care experience for our patients and community!</div><div><div><div>
Interested in this position? Apply online and create a personal candidate account!</div></div></div>
Current Employees of NeighborHealth- Please use our internal careers portal to apply for positions.
To learn more about working at NeighborHealth and our benefits, please visit out our Careers Page.
Time Type:
Full time
Department:
PACE Health Plan Management
All Locations:
300 Ocean Avenue &ndash; Revere
Position Summary:
Position Summary:
 
The Claims Analyst, under the direction of the Manager of PACE Claims, is responsible for the overall claims adjudication and insurance validation process. This includes:<div>
Claims Department: 
<ul><li>Maintaining up-to-date knowledge of fee schedules for both Medicare and MassHealth.</li><li>Ensuring the fee schedules are updated and are priced correctly in the Tapestry module.</li><li>Auditing adjudicated claims to ensure payments are made in accordance with their contracts.</li><li>Analyzing claims data to ensure accruals are reported to Finance in a timely and accurate manner.</li><li>Ensuring accuracy of claims-related cost reports.</li><li>Analyzing claims data for trends (e.g., referral matching).</li><li>Reporting any findings to PACE leadership.</li><li>Coordinating with IT to enhance and refine the claims adjudication process.</li><li>Coordinating with the Manager of PACE Claims to proactively review referrals and claims-related data in an effort to provide utilization reports to other departments.</li></ul></div><div>
Insurance Department: 
<ul><li>Must maintain up-to-date knowledge of Coordination of Benefits.</li><li>In conjunction with the Supervisor of Business Services, responsible for assisting with and developing workflows to maintain overall compliance of the Insurance Department.</li></ul></div>
Schedule: Monday - Friday 8:00am - 5:00pm
Insurance Department<ul><li>
Serves as the department Medicare expert. This includes auditing enrollment files to ensure compliance with the Part D requirements: EOBs, COB follow-up is completed timely and accurately, as well as documentation in EPIC regarding MSP surveys and TrOOP.</li><li>
Ensures primary insurance coverage is documented in EPIC and that insurance billing is appropriate.</li><li>
Responsible for the timely completion and documentation of CMS Part D reports: COB, MSP.</li><li>
Serves as back-up for Business Services Supervisor.</li></ul>
Expense Management/Claims<ul><li>
Monitors monthly expense reports to ensure that all expenses are correctly categorized and reported.</li><li>
Oversees the referral authorization process as it relates to timely and accurate claims payment and improvements to utilization management.</li><li>
Responsible for maintaining up-to-date knowledge of fee schedules and works with IT to ensure timely upload into Tapestry.</li><li>
Coordinates with the Manager of PACE Claims in an effort to improve the processes to manage claims payment and expenses based on trends analysis.</li><li>
Acts as the department claims expert regarding adjudication.</li><li>
Audits claims work queues to ensure timely and appropriate payment to vendors; suggests process improvements (e.g., referral matching table edits).</li><li>
Coordinates with Finance to ensure appropriate accruals on a monthly basis. Reviews IBNR data with Finance in an effort to ensure all claims are received.</li><li>
Works closely with the Contracts Department to review reimbursement.</li></ul>
Information Technology<ul><li>
Serves as a liaison with IT, specifically regarding Tapestry (fee schedule development, claims processing, referrals) and reports and workflows related to ESP (Elder Service Plan) Business Office processes.</li></ul>
Other Duties<ul><li>
Regularly reports to work on time and follows attendance and call-in procedures.</li><li>
Works cooperatively and respectfully with others at all levels of the organization.</li><li>
Takes the initiative to perform a wide variety of activities and be flexible in terms of work assignments based on operational needs, contributing to the smooth functioning of the department.</li><li>
Displays outstanding customer service skills when interacting with all NH customers according to the PACE model.</li><li>
Creates and/or revises policies and procedures, workflows, and guidelines, as appropriate, in any respective areas under the Business Office or as requested by Manager.</li><li>
Other duties as required.</li></ul>
PACE AND GENERAL REQUIREMENTS: KNOWLEDGE, SKILLS AND ATTITUDES (This section not applicable to initial assessment; all ESP employees and contractors attain these competencies through participation in PACE and TJC orientation programs.)<ul><li>
Demonstrates commitment to the PACE mission by actively promoting the autonomy and dignity of PACE program participants.</li><li>
Demonstrates commitment to a holistic approach to care by actively engaging in interdisciplinary team planning and communication processes.</li><li>
Demonstrates commitment to participant-centered care by actively engaging participants and/or Health Care Proxies in discussion about self-management goals.</li><li>
Understands ESP&rsquo;s organizational structure. Actively participates in NH programs and committees.</li><li>
Demonstrates the ability to communicate effectively and respectfully through verbal and written skills. Documents in accordance with protocol.</li><li>
Demonstrates knowledge of Participant Rights by:</li><li>
actively protecting rights to privacy;</li><li>
always treating participants with respect;</li><li>
encouraging and assisting participants in filing of complaints and grievances;</li><li>
helping to maintain a clean and safe environment;</li><li>
helping to ensure that restraint and involuntary seclusion are never used as a means of coercion, discipline, punishment, retaliation, or for the convenience of staff; and that those restraints, when required by extraordinary circumstance, are always applied and monitored in accordance with policy/procedure.</li><li>
Promotes a sense of &ldquo;teamwork&rdquo; through demonstration of self-direction and self-motivation. Solves problems independently or knows when to seek consultation. Provides leadership to other support staff on the practice team. Works cooperatively and respectfully with others at all levels of the organization.</li><li>
All ESP employees participate in the orientation, training, and mentoring of new employees and in providing input for continuous improvement.</li><li>
Displays outstanding customer service skills when interacting with ESP participants, family members, outside providers, potential ESP members, referral sources, or others.</li><li>
Interacts with participants in a professional and respectful manner that reflects the needs and concerns of the individual. Maintains a positive attitude. Uses communication devices appropriately.</li><li>
Demonstrates commitment to performance improvement by reporting incidents and other data used in ESP Performance Improvement activities, and by actively participating in one or more performance improvement committees or making a minimum of two suggestions for program or other improvements over the course of the year.</li><li>
Responsible for continued professional growth and development.</li></ul>
Pay Range: Starting at $26/hr up to $39/hr based on experience
EEO &amp; Accommodation Statement:
NeighborHealth is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to HRrecruit@NeighborHealth.com or call 617-568-4480 to let us know the nature of your request
Federal Trade Commission Statement: 
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website. We do not ask or require downloads of any applications, or &ldquo;apps.&rdquo; Job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
E-Verify Program Participation Statement:
NeighborHealth participates in the Electronic Employment Verification Program, E-Verify. As an E-Verify employer, all prospective employees must complete a background check before beginning employment.</div>

Analyst, Claims

Join NeighborHealth and explore 2   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.

NeighborHealth

ABOUT_COMPANY

Manager, Pharmacy Purchasing Operations

Analyst, Claims