clinical services pharmacy technician

certified pharmacy technician Jobs in Ohio

certified pharmacy technician

clinical case manager, behavioral health Jobs in Ohio

clinical case manager, behavioral health

clinical pharmacist - managed care Jobs in Ohio

clinical pharmacist - managed care

clinical pharmacy support technician Jobs in Ohio

clinical pharmacy support technician

clinical pharmacist managed care

Medical Mutual

<div>
 <ul>
 <li>
 Medical Mutual employees must submit their applications through MySource.
 </li>
 <li>
 This is a remote-based role, and we are currently seeking candidates located in Ohio.
 
 
 </li>
 </ul>
 Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
 
 
 
 Clinical Pharmacist I
 
 
 
 
 
 Job Summary:
 
 
 
 
 As assigned, supports any of the following pharmacist specialty areas; formulary and policy development, intervention programs for commercial and Medicare programs, partnering with sales team, or health systems liaison. Develops and implements evidence based clinical programs to ensure that members receive the most clinically appropriate medication cost-effectively. Evaluates evidence and applies these principles to patient care.
 
 
 
 
 Responsibilities:
 
 
 
 
 <ul>
 <li>
 Based on assigned pharmacist specialty area, may include any of the following (% of time per function will vary):
 </li>
 <li>
 Develops policies and strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to decrease drug spend.
 </li>
 <li>
 Addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps.
 </li>
 <li>
 Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support formulary, drug policy or drug therapy interventions and creation of new initiatives.
 </li>
 <li>
 Contributes with PBM/vendor oversight activities including regular or ad-hoc audits of clinical programs.
 </li>
 <li>
 Collaborates with pharmacy team members in the development and implementation of programs to communicate and educate internal staff, external brokers, strategic health systems, pharmacy chains and provider groups.
 </li>
 <li>
 Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception.
 </li>
 <li>
 Assists Sales in selling and renewing pharmacy services, or retaining business, by attending meetings, promoting pharmacy benefits and services, developing responses to Request for Proposal (RFP), recommending solutions to brokers and their clients, etc.
 </li>
 <li>
 Collaborates with pharmacy departments within the Company&rsquo;s strategic health systems, pharmacy chains and provider groups to implement programs which better engage members to improve overall medication quality performance and cost of care for attributed populations by facilitating regular interactions to build and support the clinical relationship.
 </li>
 <li>
 Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs).
 </li>
 <li>
 Partners with internal departments including Medicare STARS, Clinical Quality Health Services, Provider Network Management, HEDIS, and Customer Care to develop and implement programs and clinical initiatives to support achievement of strategic goals.
 </li>
 <li>
 Builds and maintains and clinical knowledge and knowledge of prescription benefit trends.
 </li>
 <li>
 Performs other duties as assigned.
 
 
 </li>
 </ul>
 
 
 Qualifications:
 
 
 
 
 
 Education and Experience:
 
 
 
 <ul>
 <li>
 Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.
 </li>
 <li>
 Successful completion of internal Clinical Pharmacy Resident program, or 0 to 3 years of experience as a Clinical Pharmacist, or equivalent experience in a managed care pharmacy setting.
 </li>
 <li>
 Medicare/Medicaid experience preferred.
 
 
 </li>
 </ul>
 
 
 Professional Certification(s):
 
 
 
 
 <ul>
 <li>
 Registered Pharmacist with current unrestricted license from the appropriate State Board of Pharmacy.
 </li>
 <li>
 May be required to obtain Ohio State Board of Pharmacy license within 6 months of hire.
 
 
 </li>
 </ul>
 
 
 Technical Skills And Knowledge:
 
 
 
 
 <ul>
 <li>
 Understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.
 </li>
 <li>
 Knowledge of medical/pharmacy terminology/coding and specialty drug management.
 </li>
 <li>
 Good clinical acumen.
 </li>
 <li>
 Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access.
 </li>
 <li>
 Ability to present clinical information to various internal and external audiences.
 
 
 </li>
 </ul>
 
 Clinical Pharmacist II
 
 
 
 
 
 Responsibilities:
 
 
 
 
 <ul>
 <li>
 Based on assigned pharmacist specialty area, may include any of the following (% of time per function will vary):
 </li>
 <li>
 Develops policies and strategies to engage members and/or providers and help drive improvements in pharmaceutical care and pharmacy quality measures to decrease drug spend.
 </li>
 <li>
 Addresses Medicare STAR drugs (STATIN, RASA, and non-insulin diabetes) adherence gaps.
 </li>
 <li>
 Reviews drug/medical literature, clinical practice guidelines, quality measures, and available national guidelines to support formulary, drug policy or drug therapy interventions and creation of new initiatives.
 </li>
 <li>
 Interacts with PBM/vendor oversight activities including regular or ad-hoc audits of clinical programs.
 </li>
 <li>
 Develops and implements programs to communicate and educate internal staff, external brokers, strategic health systems, pharmacy chains and provider groups.
 </li>
 <li>
 Performs Consumer Assessment of Healthcare Providers and Systems (CAHPS)-focused interventions to improve drug plan perception.
 </li>
 <li>
 Promotes the value-add of the Company&rsquo;s pharmacy services with internal and external stakeholders. Develops relationships and partnerships to support health systems engagement or sales efforts.
 </li>
 <li>
 Assists Sales in selling and renewing pharmacy services, or retaining business, by attending meetings, promoting pharmacy benefits and services, developing responses to Request for Proposal (RFP), recommending solutions to brokers and their clients, etc.
 </li>
 <li>
 Collaborates with pharmacy departments within the Company&rsquo;s strategic health systems, pharmacy chains and provider groups to implement programs which better engage members to improve overall medication quality performance and cost of care for attributed populations by facilitating regular interactions to build and support the clinical relationship.
 </li>
 <li>
 Assists in closing Medicare STARS-related gaps by completing Comprehensive Medication Reviews (CMRs), Medication Reconciliation Post-Discharge (MRPs), and In-Home Assessments (IHAs).
 </li>
 <li>
 Partners with internal departments including Medicare STARS, Clinical Quality Health Services, Provider Network Management, HEDIS, and Customer Care to develop and implement programs and clinical initiatives to support achievement of strategic goals.
 </li>
 <li>
 May orient, train, and assist new hires, residents, and junior level Pharmacists. Maintains and shares clinical knowledge and knowledge of prescription benefit trends.
 </li>
 <li>
 Performs other duties as assigned.
 
 
 </li>
 </ul>
 
 
 Education And Experience:
 
 
 
 
 <ul>
 <li>
 Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.
 </li>
 <li>
 3 years of experience as a Clinical Pharmacist or equivalent experience in a managed care pharmacy setting.
 </li>
 <li>
 Medicare/Medicaid experience preferred.
 
 
 </li>
 </ul>
 
 
 Technical Skills And Knowledge:
 
 
 
 
 <ul>
 <li>
 Understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.
 </li>
 <li>
 Knowledge of medical/pharmacy terminology/coding and specialty drug management.
 </li>
 <li>
 Good clinical acumen and strategic analysis skills.
 </li>
 <li>
 Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access.
 </li>
 <li>
 Ability to present clinical information to various internal and external audiences.
 
 
 </li>
 </ul>
 
 Sr Clinical Pharmacist
 
 
 
 
 
 Job Summary:
 
 
 
 
 Applies a thorough understanding of clinical pharmacy programs including formulary design, prescription benefit trends, and translates complex clinical information into actionable strategies. Administers formulary design and drug policy within the clinical systems of the Pharmacy Benefit Manager (PBM). Keeps apprised of prescription benefit trends and pipeline, ensuring programs are set for success as the landscape of pipeline evolves. Presents, translates, and communicates complex clinical information for diverse group benefit plan audiences.
 
 
 
 
 Responsibilities:
 
 
 
 
 <ul>
 <li>
 Provides clinical support for formulary and policy development in the administration of pharmacy benefits. Identifies new opportunities for drug management, including safety programs, and medical/pharmacy cost savings.
 </li>
 <li>
 Collaborates with Chief Medical Officer, other Physician leadership, and related staff to perform utilization review of drugs to develop drug medical policies, research new drugs for possible utilization, education staff/customers and identify administration of those policies.
 </li>
 <li>
 Interprets standards published by national accrediting bodies, gathers and documents supporting evidence demonstrating compliance with said standards. Collaborates with external delegate(s) and Pharmacy Management department with regard to accreditation standard oversight.
 </li>
 <li>
 Represents the department or division in activities or projects as assigned by management.
 </li>
 <li>
 Provides oversight of PBM or third-party vendors by conducting regular audits of clinical program implementation and operations.
 </li>
 <li>
 Conducts internal and external appeal reviews and works with medical directors to decision cases and complete Independent Review Organization (IRO) submissions.
 </li>
 <li>
 May lead projects for existing staff and acts as a resource to newly hired staff, supporting management with training, assigned projects, and goals.
 </li>
 <li>
 Reviews drug/medical literature, clinical practice guidelines, and available national guidelines to support drug policy development and consultation over various medical and pharmacy clinical programs
 </li>
 <li>
 Orients, trains, and assists new hires, residents, and junior level Pharmacists. Develops and maintains policies and procedures to support team as needed. Maintains and shares knowledge of prescription benefit trends.
 </li>
 <li>
 Performs other duties as assigned.
 
 
 </li>
 </ul>
 
 
 Education And Experience:
 
 
 
 
 <ul>
 <li>
 Doctor of Pharmacy (Pharm.D.) preferred. Bachelor of Pharmacy with relevant experience may be considered.
 </li>
 <li>
 5 years of experience as a Clinical Pharmacist or equivalent experience in a managed care pharmacy setting.
 
 
 </li>
 </ul>
 
 
 Technical Skills And Knowledge:
 
 
 
 
 <ul>
 <li>
 Comprehensive understanding of managed care pharmacy, including formulary design/management, drug utilization management, and/or quality assurance programs.
 </li>
 <li>
 Knowledge of medical/pharmacy terminology/coding and specialty drug management.
 </li>
 <li>
 Strong clinical acumen and strategic analysis skills.
 </li>
 <li>
 Advanced Microsoft Office skills specifically Excel and Pharmacy Benefit Management (PBM) systems; basic proficiency with Visio and/or Access.
 </li>
 <li>
 Ability to present clinical information to various internal and external audiences.
 
 
 </li>
 </ul>
 
 A Great Place To Work:
 
 
 
 Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
 
 
 <ul>
 <li>
 We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
 </li>
 <li>
 Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
 </li>
 <li>
 On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
 </li>
 <li>
 Discounts at many places in and around town, just for being a Medical Mutual team member.
 </li>
 <li>
 The opportunity to earn cash rewards for shopping with our customers.
 </li>
 <li>
 Business casual attire, including jeans.
 
 
 </li>
 </ul>
 
 Excellent Benefits And Compensation:
 
 
 
 <ul>
 <li>
 Employee bonus program.
 </li>
 <li>
 401(k) with company match up to 4% and an additional company contribution.
 </li>
 <li>
 Health Savings Account with a company matching contribution.
 </li>
 <li>
 Excellent medical, dental, vision, life and disability insurance &mdash; insurance is what we do best, and we make affordable coverage for our team a priority.
 </li>
 <li>
 Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
 </li>
 <li>
 Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
 </li>
 <li>
 After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
 
 
 </li>
 </ul>
 
 An Investment In You:
 
 
 
 <ul>
 <li>
 Career development programs and classes.
 </li>
 <li>
 Mentoring and coaching to help you advance in your career.
 </li>
 <li>
 Tuition reimbursement up to $5,250 per year, the IRS maximum.
 </li>
 <li>
 Diverse, inclusive and welcoming culture with Business Resource Groups.
 
 
 </li>
 </ul>
 
 About Medical Mutual:
 
 
 
 Medical Mutual&rsquo;s status as a mutual company means we are owned by our policyholders, not stockholders, so we don&rsquo;t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
 
 
 There&rsquo;s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
 
 
 We&rsquo;re not just one of the largest health insurance companies based in Ohio, we&rsquo;re also the longest running. Founded in 1934, we&rsquo;re proud of our rich history with the communities where we live and work.
 
 
 
 We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
 
 
 
</div>

Clinical Pharmacist - Managed Care

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
A Brief Overview
Administers operational support to clinical pharmacy staff. Conducts outreach to providers, pharmacists, and members. Supports day-to-day processes, reviews data, and documents relevant interactions. 
Position Summary
Primary responsibility is supporting Formulary Alternative Outreach Program for Medicare Part D. The Clinical Support Technician will support the operations of the Retro DUR (Drug Utilization Review)/Scorable Action Items (SAI) Clinical Pharmacy staff. This will include outreach calls to providers, pharmacists, and members. Responsibilities also include managing day-to-day processes, analyzing data, organizing and documenting all relevant interactions.<ul><li>
Executes both routine and non-routine business support tasks for the Clinical Pharmacy Support area under limited supervision, referring deviations from standard practices to managers.</li><li>
Follows area protocols, standards, and policies to provide effective and timely support.</li><li>
Conducts reviews to ensure members receive the appropriate therapy as approved by the provider, determines therapy timelines, and determines claim appropriateness.</li><li>
Initiates education for providers and pharmacies on medication options, enhancements, and alternative therapy options for members.</li><li>
Communicates with pharmacies to verify claim information and reverse unnecessary claims.</li><li>
Ability to solve problems and make decisions independently</li><li>
4+ years&rsquo; work experience</li><li>
Responsible for making prescriber and or pharmacy outreach which includes reviewing formulary vs. non-formulary prescription claims.</li><li>
Ensure member is receiving the appropriate therapy as approved by the provider and determine length of therapy and establish if current claims are appropriate.</li><li>
Review therapeutic duplication data and contact providers and pharmacies to establish correct therapy for members.</li><li>
Responsible for prescriber outreach for specific Scoreable Action Item initiatives. Work with team Pharmacist to investigate specific cases of overutilization including potential member outreach to ensure member has received products that have been dispensed under plan.</li><li>
Maintain expert knowledge in most areas of pharmacy operations. Ability to analyze and interpret various types of complex claim data under member plans. Work with pharmacies to verify claims information and reverse unnecessary claims.</li><li>
Identify opportunities for improvement in departmental and pharmacy operations with recommendations for modes of resolution.</li><li>
Train, coach, and mentor new Clinical Support Technician Staff.</li></ul>
Work from Home: Monday - Friday
Schedule: Monday - Friday, 8:00a - 5:00p local time 
Required Qualifications<ul><li>
4 or more years&rsquo; relevant experience</li><li>
Valid Pharmacy Technician Certification (PTCB or ExCPT)</li><li>
Working knowledge of Microsoft Outlook and Teams</li><li>
Ability to interpret Pharmacy Claims data</li><li>
Proficiency in computerized pharmacy systems and software applications</li><li>
Previous provider/pharmacy outreach experience</li><li>
Ability to perform duties with minimal supervision</li><li>
Proficient knowledge of Brand/Generic drug names</li></ul> 
Preferred Qualifications<ul><li>
Managed Care experience</li><li>
Advanced knowledge of Microsoft Office applications</li><li>
Understanding of medical and pharmacy terminology</li></ul>
Education<ul><li>
High School Diploma or equivalent</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $38.82
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 04/30/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Clinical Pharmacy Support Technician

Gainwell Technologies

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 Gainwell Technologies is seeking a Certified Pharmacy Technician - Remote US to support a high-volume PBM clinical and technical call center environment. In this fully remote role, you will assist with provider inquiries, process prior authorizations, and help ensure timely, accurate resolution of pharmacy-related requests while maintaining compliance with HIPAA, state regulations, and internal quality standards.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Process prior authorization requests within required turnaround times and complete approvals when pharmacist review is not needed.
 </li>
 <li>
 Handle provider inquiries efficiently across phone, email, fax, and web-based channels, aiming for first-contact resolution whenever possible.
 </li>
 <li>
 Conduct outbound communication to providers to obtain missing information and support closure of pending prior authorization cases.
 </li>
 <li>
 Accurately document all interactions, decisions, and follow-up actions in the appropriate systems.
 </li>
 <li>
 Follow established workflows, productivity expectations, and quality standards while identifying opportunities for process improvement.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 Active Certified Pharmacy Technician (CPhT) certification and/or active Pharmacy Technician registration as required by applicable Board of Pharmacy regulations.
 </li>
 <li>
 At least 2 years of pharmacy technician experience, preferably in retail, hospital, managed care, PBM, insurance, or prior authorization support.
 </li>
 <li>
 Strong knowledge of drug terminology, pharmacy operations, and pharmacy benefit or claims-related processes.
 </li>
 <li>
 Experience working in a fast-paced, metrics-driven environment with strong attention to detail and accuracy.
 </li>
 <li>
 Proficiency in Microsoft Office applications and the ability to quickly learn internal systems and workflows.
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Fully remote position supporting a high-volume call center operation.
 </li>
 <li>
 Frequent interaction with providers through phone, email, fax, and web portals.
 </li>
 <li>
 Strict adherence to HIPAA, PHI, regulatory, and turnaround-time requirements.
 </li>
 <li>
 Performance expectations tied to productivity, quality, and service metrics.
 </li>
 <li>
 Comprehensive benefits package including medical, dental, vision, 401(k) with company match, paid time off, floating holidays, and wellness programs.
 
 
 </li>
 </ul>
 The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You&rsquo;ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
 
 
 We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You&rsquo;ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
 
 
 
 Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
 
 
</div>

Certified Pharmacy Technician - Remote US

Gainwell Technologies LLC

<div>It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.<div><div><div><h2 class="jobSectionHeader"> 
Summary</h2></div><div>
Gainwell Technologies is seeking a Certified Pharmacy Technician - Remote US to support a high-volume PBM clinical and technical call center environment. In this fully remote role, you will assist with provider inquiries, process prior authorizations, and help ensure timely, accurate resolution of pharmacy-related requests while maintaining compliance with HIPAA, state regulations, and internal quality standards.</div></div><div><div><h2 class="jobSectionHeader">
Your role in our mission</h2></div><div><ul><li>
Process prior authorization requests within required turnaround times and complete approvals when pharmacist review is not needed.</li><li>
Handle provider inquiries efficiently across phone, email, fax, and web-based channels, aiming for first-contact resolution whenever possible.</li><li>
Conduct outbound communication to providers to obtain missing information and support closure of pending prior authorization cases.</li><li>
Accurately document all interactions, decisions, and follow-up actions in the appropriate systems.</li><li>
Follow established workflows, productivity expectations, and quality standards while identifying opportunities for process improvement.</li></ul></div></div><div><div><h2 class="jobSectionHeader">
What we're looking for</h2></div><div><ul><li>
Active Certified Pharmacy Technician (CPhT) certification and/or active Pharmacy Technician registration as required by applicable Board of Pharmacy regulations.</li><li>
At least 2 years of pharmacy technician experience, preferably in retail, hospital, managed care, PBM, insurance, or prior authorization support.</li><li>
Strong knowledge of drug terminology, pharmacy operations, and pharmacy benefit or claims-related processes.</li><li>
Experience working in a fast-paced, metrics-driven environment with strong attention to detail and accuracy.</li><li>
Proficiency in Microsoft Office applications and the ability to quickly learn internal systems and workflows.</li></ul></div></div><div><div><h2 class="jobSectionHeader">
What you should expect in this role</h2></div><div><ul><li>
Fully remote position supporting a high-volume call center operation.</li><li>
Frequent interaction with providers through phone, email, fax, and web portals.</li><li>
Strict adherence to HIPAA, PHI, regulatory, and turnaround-time requirements.</li><li>
Performance expectations tied to productivity, quality, and service metrics.</li><li>
Comprehensive benefits package including medical, dental, vision, 401(k) with company match, paid time off, floating holidays, and wellness programs.</li></ul>
#LI-REMOTE
#LI-JT</div></div></div> 
The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You&rsquo;ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. 
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You&rsquo;ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. 
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.</div>

CenterWell Pharmacy

<div>
 
 Become a part of our caring community
 
 
 
 Become a part of our caring community and help us put health first
 
 
 The Mail Operations Pharmacist 2 will report to a supervisor in the department and is responsible for the accurate dispensing of prescribed medication to patients. The Mail Operations Pharmacist 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
 
 
 The Mail Operations Pharmacist ensures adherence to quality assurance standards, accurate tracking techniques and a review process prior to shipping medications to patients.
 
 
 
 As a Member Of The Team, You Will
 
 
 
 <ul>
 <li>
 Partner to influence department's strategy.
 </li>
 <li>
 Work independently utilizing shared resources and communicate effectively with a team to collaborate and problem solve.
 </li>
 <li>
 Maintain accuracy in a highly productive work environment.
 </li>
 <li>
 Exercise considerable latitude in determining objectives and approaches to assignments.
 
 
 </li>
 </ul>
 
 Use Your Skills To Make An Impact
 
 
 
 Use your skills to make an impact
 
 
 
 Required Qualifications
 
 
 
 <ul>
 <li>
 You are required to have a Pharmacy degree from an accredited college of pharmacy
 </li>
 <li>
 You are required to be actively licensed as a Pharmacist in Arizona, Florida, Ohio or Texas without disciplinary action.
 </li>
 <li>
 You must have a minimum three, (3) years of experience as a Registered Pharmacist in a high-volume retail, community, or traditional mail order pharmacy practice environment.
 </li>
 <li>
 You must have the ability to participate in Federal prescription programs
 </li>
 <li>
 You are required to be Proficient with computers such as MS Office, Word, Excel, Outlook, Teams, Zoom, SharePoint and troubleshoot and resolve general technical difficulties such as your home internet/modem.
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 PharmD
 </li>
 <li>
 Bilingual in both English and Spanish - You will be required to pass a language assessment.
 
 
 </li>
 </ul>
 
 Additional Information
 
 
 
 
 Workstyle:
 
 Remote Work at Home
 
 
 
 Location:
 
 Must reside and work in the Florida, Arizona, Texas, or Ohio
 
 
 
 Schedule:
 
 The schedule will be set between 8am-8pm EST Monday-Friday and 8:00 am-4:30 pm EST Saturday.
 
 
 
 Travel
 
 While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
 
 
 <ul>
 <li>
 Annual shift bids are conducted, and schedule changes may occur dependent upon business need.
 </li>
 <li>
 Mandatory Overtime may be required if business need arises but will not exceed 10 hours per week.
 
 
 </li>
 </ul>
 Work At Home Guidance 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 required; 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 Alert
 
 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.
 
 
 
 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.
 
 
 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
 
 
 
 Scheduled Weekly Hours
 
 
 
 40
 
 
 
 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.
 
 
 $104,000 - $143,000 per year
 
 
 This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
 
 
 
 Description Of Benefits
 
 
 
 Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
 
 
 
 About Us
 
 
 
 About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.
 
 
 About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.
 
 
 
 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.
</div>

Dr Call Mail Order Pharmacist

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary:
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. 
Assessment of Members:<ul><li>
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member&rsquo;s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member&rsquo;s benefit plan and available internal and external programs/services.</li><li>
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.</li><li>
Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.</li><li>
Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.</li></ul>
Enhancement of Medical Appropriateness and Quality of Care:<ul><li>
Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member&rsquo;s needs to ensure appropriate administration of benefits</li><li>
Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes</li><li>
Identifies and escalates quality of care issues through established channels</li><li>
Ability to speak to medical and behavioral health professionals to influence appropriate member care.</li><li>
Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health</li><li>
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.</li><li>
Helps member actively and knowledgably participate with their provider in healthcare decision-making</li><li>
Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.</li></ul> 
Monitoring, Evaluation and Documentation of Care<ul><li>
In collaboration with the member and their care team develops and monitors established plans of care to meet the member&rsquo;s goals</li><li>
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.</li><li>
Ability to take and manage crisis calls.</li></ul> 
Required Qualifications:<ul><li>
Unencumbered Independent Behavioral Health clinical license in the state where they reside and work:</li></ul><h3 class="jobSectionHeader">
Licensed Mental Health Counselor (LMHC)</h3><h3 class="jobSectionHeader">
Licensed Clinical Social Worker (LCSW)</h3><h3 class="jobSectionHeader">
Licensed Independent Social Worker (LISW)</h3><h3 class="jobSectionHeader">
Licensed Marital and Family Therapist (LMFT)</h3><h3 class="jobSectionHeader">
Licensed Professional Counselor (LPC)</h3><ul><li>
3+ years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility</li><li>
3+ years minimum of Behavioral Health experience</li><li>
Applicants must be willing to work standard business hours in EST or CST.</li></ul> 
Preferred Qualifications<ul><li>
Case management and discharge planning experience
</li><li>Crisis intervention skills
</li><li>Managed care/utilization review experience
</li><li>Ability to take and manage crisis calls</li></ul>
Education
Minimum of a Master&rsquo;s degree in Behavioral/Mental Health or related field
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,095.00 - $142,576.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 05/02/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Clinical Case Manager, Behavioral Health

<div>
 
 Become a part of our caring community
 
 
 
 As a Clinical Services Pharmacy Technician, you will intake for all calls from patients, pharmacies and providers. You will perform basic administrative/clerical/operational/customer support/computational tasks. Typically work on routine and patterned assignments.
 
 
 You will address questions related to specific assigned area and assist with medication research. You will evaluate calls that require consultation with a pharmacist. You will make outbound calls to patients to offer medication therapy management programs and schedules medication review sessions with consultative pharmacists. Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.
 
 
 
 Required Qualifications
 
 
 
 
 Use your skills to make an impact
 
 
 
 
 Candidates MUST reside in one of the following states: Arizona, Ohio, Texas, or Florida.
 
 
 
 <ul>
 <li>
 Must have an active Pharmacy Technician or Tech in Training license in the state you reside
 </li>
 <li>
 Technical Mail Order Pharmacy or Manufacturing experience
 </li>
 <li>
 Experience as a Pharmacy Technician OR call center experience in a pharmacy or related call center setting
 </li>
 <li>
 Experience using multiple computer applications simultaneously and strong data entry skills
 
 
 </li>
 </ul>
 
 Required Work Schedule
 
 
 
 <ul>
 <li>
 10:30am - 7:00pm EST Monday-Friday.
 </li>
 <ul>
 <li>
 You must also be available to work every 3rd Saturday 10:00am - 6:30pm EST with a day off during the week when it is your Saturday rotation.
 
 </li>
 </ul>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 PTCB or ExCPT Certified
 </li>
 <li>
 High School Diploma or GED
 </li>
 <li>
 Bilingual in English / Spanish with the ability to speak, read, and write in both languages without limitations or assistance.
 
 
 </li>
 </ul>
 
 Additional Information
 
 
 
 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:
 
 
 <ul>
 <li>
 At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
 </li>
 <li>
 Satellite, cellular and microwave connection can be used only if approved by leadership.
 </li>
 <li>
 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.
 </li>
 <li>
 Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
 </li>
 <li>
 Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
 
 
 </li>
 </ul>
 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
 
 
 
 Scheduled Weekly Hours
 
 
 
 40
 
 
 
 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.
 
 
 $40,000 - $52,300 per year
 
 
 
 Description Of Benefits
 
 
 
 Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
 
 
 
 About Us
 
 
 
 About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.
 
 
 About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.
 
 
 
 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.
</div>

Clinical Services Pharmacy Technician

Explore 46+ Clinical pharmacist managed care in Ohio this May. Find roles across top companies and apply now to boost your career.

46 clinical pharmacist managed care jobs In Ohio

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Dr Call Mail Order Pharmacist

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Clinical Services Pharmacy Technician