pharmacy benefit manager

Molina Healthcare

Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. Candidates must be licensed to practice in the state of Florida or be able to obtain Florida licensure within 90 days of starting. This position is remote and can be worked from a variety of locations within the US. Shift times can be either 8 or 10 hour shifts between the times of 7a and 10p EST with rotating weekends depending on business needs. Molina Pharmacy Services/Management staff work to ensure that Molina members have access to all medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These jobs are responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and state laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). KNOWLEDGE/SKILLS/ABILITIES The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a formulary and drug information resource, assisting technicians and other departments with questions regarding drug coverage. <ul><li>Acts as a liaison between Molina and its customers (members, providers and pharmacies) with respect to the pharmacy benefit.</li><li>Serves as the formulary expert.</li><li>Ensures Molina is compliant with the coverage determination and appeals process.</li><li>Contributes to projects aimed at improving Star ratings, HEDIS, CAHPS, and other quality metrics.</li><li>Assists call center pharmacy technicians with clinical questions and phone calls from prescribers, pharmacies and/or members.</li><li>Develops, implements and maintains pharmacy cost control and quality initiatives under the direction of leadership.</li><li>Monitors drug utilization and assists leadership team in understanding quality and cost control issues related to pharmacy.</li><li>Works in tandem with Molina Medical Directors to ensure accurate coverage determination decisions.</li><li>Works with leadership on developing annual training sessions for applicable staff regarding the pharmacy benefit changes for the upcoming year.</li><li>Works with the Case Management department as part of a member-centered interdisciplinary care team.</li><li>Works with the PBM to manage formulary changes and update marketing on any changes needed on the web or print versions of the formulary.</li><li>Performs outreach to patients and physicians as part of quality and/or cost control initiatives.</li><li>Provides leadership for the pharmacy call center team as delegated by the Manager.</li><li>Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence.</li></ul>JOB QUALIFICATIONS Required Education <ul><li>Doctor of Pharmacy or bachelor&rsquo;s degree in pharmacy with equivalent experience.</li><li>Continuing education required to maintain an active pharmacist license.</li></ul>Required Experience: 1 - 2 years post-graduate experience. Required License, Certification, Association: Active and unrestricted State Pharmacy License for workplace and plan location. Preferred Experience <ul><li>Medicare Part D or Medicaid experience.</li><li>Managed care experience.</li></ul>To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. #PJPharm2 #LI-AC1 Pay Range: $80,412 - $156,803.45 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Pharmacist, Prior Auth/Utilization Management, Remote

Onco360

<div><div>Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Senior Pharmacy Benefit Verification Specialist for our Pharmacy located in Louisville, KY. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
</div>
<div></div><div>Current shift available: 10:30am-7:00pm EST</div>
<div></div><div>**Starting salary at $26/HR and up**</div>
<div></div><div><div>We offer a great benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul></div><div><div>Senior Pharmacy Benefit Verification Specialist Major Responsibilities:</div>
<div>The Senior Benefit Verification Specialist will work closely with the Senior Manager, Patient Benefits to ensure completion of challenging cases and escalations in their designated vertical. Senior Benefits Verification Specialists will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders. They may also assist with training employees, and other duties as assigned.</div>
<ul><li>Works and resolve difficult or escalated cases to assist in processing prescription orders</li>
<li>Participates in the orientation and training of benefit verification specialists within workflow vertical</li>
<li>Escalates workflow/process improvement ideas to leadership</li>
<li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information</li>
<li>Performs full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile</li>
<li>Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy</li>
<li>Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. 
</li></ul><div>Senior Pharmacy Benefit Verification Specialist Qualifications:</div>
</div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associates or Bachelor&rsquo;s Degree, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul></li><li>Work Experience
<ul><li>Required: 2+ years pharmacy or benefit verification experience</li>
<li>Desired: 3+ years pharmacy or benefit verification experience</li>
</ul></li><li>Skills/Knowledge:
<ul><li>Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. 
Desired: Specialty pharmacy experience, leadership skills</li>
</ul></li><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li><li>Behavior Competencies
<ul><li>Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills</li></ul></li></ul></div>

Senior Pharmacy Benefit Verification Specialist

Paratek Pharmaceuticals

<div>Position Title: Pharmacy Experience Associate

Department: Commercial - Market Access
Reports To (title): Associate Director Field Reimbursement and Patient Services

Location: Remote - Texas
<ul><li>Exempt Non-Exempt
</li></ul>We are looking for resourceful, collaborative, passionate and purposeful professionals who want to be part of a fast-moving, entrepreneurial environment, where transformational patient solutions are developed!

Summary of Position:
The Pharmacy Experience Associate (PEx) interacts with both internal and external individuals to compliantly support patient access and affordability challenges. This individual has a strong understanding of the variety of patient services that are available and will work efficiently with Healthcare Professionals (HCPs) and pharmacies to support questions related to prescription fulfillment. The incumbent will assess training and education needs of Prescribers, medical office staff, and Pharmacists to support the accurate submission and fulfillment of future prescriptions for the appropriate patient. This individual understands patient access and payer related challenges as well as the complexity of the pharmacy and prescription process. The Pharmacy Experience Associate escalates more complicated cases to the Field Reimbursement and Patient Services Team. They work with a sense of urgency while focused on clear and succinct communication with all parties involved.

This role will be part of the Paratek Market Access team and will report to the Executive Director, Trade Relations, and Patient Services.

Position Responsibilities:
<ul><li>Utilizing data insights, identify prescriptions that are delayed or stalled and take appropriate action.</li>
<li>Establish, develop, and maintain working relationships with regional network specialty pharmacies, their leadership, and staff.</li>
<li>Inform pharmacists and their staff on patient access and affordability programs that could be beneficial to patients.</li>
<li>Work with HCPs to support complete, accurate and timely prescription submissions to Network specialty pharmacies or health plans, to minimize delay in therapy.</li>
<li>Serve as a Network Specialty Pharmacy partner within assigned geography and communicate with stakeholders in a timely manner.</li>
</ul><ul><li>Maintain a strong working relationship with sales and sales leadership.</li>
<li>Assist the Field Reimbursement and Patient Services Team in identifying opportunities for continuous process improvements through root cause analysis and identifying ongoing training needs.</li>
<li>Conduct needs assessment and provides appropriate education for HCPs (i.e., CoverMyMeds, Prior Authorization (PA) process, pharmacy process).</li>
<li>Coordinate cases with patient support service program representatives (HUB) to ensure patient and physician needs are being addressed in a timely manner.</li>
<li>Educate physician office staff on the use of patient assistance programs and call center support services, including web-based provider programs.</li>
<li>Attend POAs and Regional conference calls, providing education, training, and feedback on the positioning of our network pharmacies and the current market access environment, to ensure a clear path for HCP and the patient.</li>
<li>Provide timely information on patient access to the National Account Directors so they are informed and up to date on pharmacy claims and PA process for PBMs and payers.</li>
<li>Collaborate with the Field Reimbursement and Patient Services Team on patient cases that need additional support and training activities with network pharmacies.</li>
<li>Maintain the highest level of ethical obligations and ensure that all activities are complied with applicable laws and regulations.</li>
<li>When called on for business travel manage personal travel schedule and travel arrangements.</li>
<li>Prepare and submit appropriate expense reports in a timely fashion.</li>
</ul>
Candidate Requirements:
<ul>
<li>Bachelor&rsquo;s degree preferred or Licensed / Certified Pharmacy Technician with at least 5+ years of experience; including work with a Pharmacy Benefit Manager, Health Plan, or healthcare provider&rsquo;s office, managing the prescription fulfillment process.</li>
<li>Demonstrated working knowledge of pharmacy benefit design (Commercial, Medicare Part D, Medicaid, and prior authorization processes)</li>
</ul><ul><li>Experience working with pharmacies and/or office-based physician practices preferred.</li>
<li>Understand and comply with HIPAA rules and regulations related to patient privacy.</li>
<li>Demonstrated ability to thrive in a dynamic, fast-paced environment with date sensitive deadlines. Identifying issues quickly and provide solutions.</li>
<li>Strong interpersonal skills and the ability to develop strong working relationships and work collaboratively across cross-functional teams.</li>
<li>Ability to deliver presentations with small and large groups.</li>
<li>Strong written and oral communication skills; and excellent planning and organizational skills.</li>
<li>Demonstrates strong attention to detail.</li>
<li>Ability to work with data and quickly analyze trends and take appropriate action.</li>
<li>Ability to work independently and within a team.</li>
</ul>
Additional Information:
<ul>
<li>Technology needs: Microsoft Office</li>
<li>Travel requirements (%): The average travel for this position is &lt;10% with some variation based upon the time of year and demands of the business imperatives. The travel requirements will vary based on the geography and account responsibilities for this position.</li></ul></div>

Pharmacy Experience Associate (Texas)

GEHA Health

<div>
 
 Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.
 
 
 
 
 
 G.E.H.A has one mission: To empower federal workers to be healthy and well.
 
 
 
 
 
 
 
 
 The Utilization Management and Oversight Pharmacist will assist with corporate strategy to achieve better healthcare value and lower cost for our members, while ensuring quality pharmaceutical care for our members, in an effort to make our insurance product more competitive and support growth.
 
 
 
 
 
 The Utilization Management and Oversight Pharmacist widely supports the operation of the pharmacy benefit and its functional teams. The position will be responsible for the following:
 
 
 &bull; Insuring proper medication utilization among our membership
 
 
 &bull; Developing and maintaining customized prior authorization criteria
 
 
 &bull; Developing and maintaining custom benefit exclusions
 
 
 &bull; Completing enterprise-wide drug information requests
 
 
 &bull; Preparing pharmacy recommendations for the pharmacy leadership
 
 
 &bull; Proposing and implementing pharmacy benefit design changes
 
 
 &bull; Increasing member outcomes by collaborating with other departments within the enterprise
 
 
 &bull; Supporting utilization review strategies and risk management related to the utilization of pharmaceuticals
 
 
 &bull; Collaborating with staff responsible for day-to-day activities of the Pharmacy Department
 
 
 &bull; Coordinating with other departments within the organization (ie: Care Management, SIU, Product, Marketing) to support strategic and operational objectives of the Pharmacy Department.
 
 
 
 
 
 
 
 SKILLS
 
 
 
 
 
 
 SKILLS
 
 
 
 
 
 Clinical Pharmacist; Utilization Management and Oversight
 
 
 
 Duties and Responsibilities
 
 <ul>
 <li>
 Responsible for day-to-day management of clinical pharmacy needs within the department including controlled substance monitoring, high risk member monitoring, high dollar claim monitoring and customized prior authorization criteria and exclusion management
 </li>
 <li>
 Collaborates with plan level associates (including Pharmacy Vice President and Managers, Care Management, Medical Directors, Quality Management and others as necessary) to identify members requiring clinical pharmacy intervention(s)
 </li>
 <li>
 Independently completes accurate and comprehensive medication reviews and performs the corresponding member, care management, and other outreach as necessary
 </li>
 <li>
 Researches and synthesizes detailed clinical data related to pharmaceuticals to identify opportunities for improving quality or overall cost
 </li>
 <li>
 Serves as pharmacy SME on projects and clinical care activities; supports internal business partners such as Product Development, Care and Case Managers, Special Investigations, and Medical Operations
 </li>
 <li>
 Leads, manages and/or supports medical cost management, utilization management and medication management initiatives, projects and related activities
 </li>
 <li>
 Assists in pharmacy medication exception reviews coming in from multiple sources including OPM, PBM, GEHA Executive Leadership, GEHA Appeals Department, etc.
 </li>
 <li>
 Assists member-facing pharmacy staff by providing medication therapy evaluations, recommendations and next steps for members and providers
 </li>
 <li>
 Works in partnership with the Vice President and Clinical Manager of Pharmacy to plan, implement and maintain clinical programs and services
 </li>
 <li>
 Serves as clinical pharmacy resource and drug information specialist to medical, pharmacy, nursing and SIU staff
 </li>
 <li>
 Reviews medical policy drafts and provides recommendations for change to medical policy staff
 </li>
 <li>
 Assists member-facing pharmacy staff in assembling responses for prescriber/member appeals, grievances, disputes, inquiries and reconsiderations within established time periods
 </li>
 <li>
 Supports clinical quality and corporate HEDIS measures by providing pharmacy perspective and developing strategies to achieve goals
 </li>
 <li>
 Serves on internal committees and/or workgroups and completes special projects as assigned
 </li>
 </ul>
 
 
 
 
 Job Qualifications
 
 
 
 Education
 
 
 <ul>
 <li>
 Doctor of Pharmacy (PharmD) degree from an ACPE-accredited School of Pharmacy
 </li>
 <li>
 Postgraduate training/residency required
 </li>
 </ul>
 
 
 Experience
 
 
 <ul>
 <li>
 Candidate must be licensed, or eligible for licensure, within the state of Missouri
 </li>
 <li>
 Candidate must have 5 years of experience, or completion of a PGY-1/PGY-2 residency with a managed care and/or drug information focus preferred
 </li>
 <li>
 Experience should include managed care
 </li>
 <li>
 Minimum three (3) years of managed care experience that has involved interaction with patients, providers and other healthcare professionals
 </li>
 <li>
 Knowledge of managed care pharmacy principles including medical exception reviews, formulary management, and utilization review required
 </li>
 <li>
 Candidate should possess an extensive understanding of evidence-based pharmacy practice, including disease specific therapies along with knowledge and ability to search medical literature for supporting clinical references
 </li>
 </ul>
 
 
 Skills/Certifications
 
 
 <ul>
 <li>
 Must contribute to the One Team value of GEHA, be organized and have the ability to handle multiple projects
 </li>
 <li>
 Exemplary interpersonal, communication and organizational skills
 </li>
 <li>
 Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles, and accountability
 </li>
 <li>
 Proficient in Microsoft Office (Outlook, Word, Excel, Vizio and PowerPoint)
 </li>
 <li>
 Solid understanding of government scope (FEHB, OPM, FDA, ACA, USPSTF) required
 </li>
 <li>
 Competency in compendia navigation and research
 </li>
 </ul>
 
 
 
 
 Work-at-home requirements
 
 <ul>
 <li>
 Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
 </li>
 <li>
 A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
 </li>
 <li>
 Latency (ping) response time lower than 80 ms
 </li>
 <li>
 Hotspots, satellite and wireless internet service is NOT allowed for this role.
 </li>
 <li>
 A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
 </li>
 </ul>
 
 
 
 
 How we value you
 
 <ul>
 <li>
 Competitive pay/salary ranges
 </li>
 <li>
 Incentive plan
 </li>
 <li>
 Health/Vision/Dental benefits effective day one
 </li>
 <li>
 401(k) retirement plan: company match &ndash; dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
 </li>
 <li>
 Robust employee well-being program
 </li>
 <li>
 Paid Time Off
 </li>
 <li>
 Personal Community Enrichment Time
 </li>
 <li>
 Company-provided Basic Life and AD&amp;D
 </li>
 <li>
 Company-provided Short-Term &amp; Long-Term Disability
 </li>
 <li>
 Tuition Assistance Program
 </li>
 </ul>
 
 
 
 
 While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine.
 
 
 
 
 
 Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate&rsquo;s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.
 
 
 
 
 
 The hiring range for this position is $118,092 - $149,394 USD. At G.E.H.A, the current maximum salary for this role is $166,468 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization.
 
 
 
 
 
 G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees.
 
 
 
 
 
 G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.
 
</div>

Clinical Pharmacist, Utilization Management and Oversight

<div>
 
 Position Title: Pharmacy Experience Associate
 
 
 
 
 Department: Commercial - Market Access
 
 
 
 
 Reports To (title): Associate Director Field Reimbursement and Patient Services
 
 
 
 
 Location: Remote - Carolinas (Charlotte preferred)
 
 
 
 ☒ Exempt ☐ Non-Exempt
 
 
 We are looking for resourceful, collaborative, passionate and purposeful professionals who want to be part of a fast-moving, entrepreneurial environment, where transformational patient solutions are developed!
 
 
 
 Summary of Position:
 
 
 
 The Pharmacy Experience Associate (PEx) interacts with both internal and external individuals to compliantly support patient access and affordability challenges. This individual has a strong understanding of the variety of patient services that are available and will work efficiently with Healthcare Professionals (HCPs) and pharmacies to support questions related to prescription fulfillment. The incumbent will assess training and education needs of Prescribers, medical office staff, and Pharmacists to support the accurate submission and fulfillment of future prescriptions for the appropriate patient. This individual understands patient access and payer related challenges as well as the complexity of the pharmacy and prescription process. The Pharmacy Experience Associate escalates more complicated cases to the Field Reimbursement and Patient Services Team. They work with a sense of urgency while focused on clear and succinct communication with all parties involved.
 
 
 This role will be part of the Paratek Market Access team and will report to the Executive Director, Trade Relations, and Patient Services.
 
 
 
 Position Responsibilities:
 
 
 
 <ul>
 <li>
 Utilizing data insights, identify prescriptions that are delayed or stalled and take appropriate action.
 </li>
 <li>
 Establish, develop, and maintain working relationships with regional network specialty pharmacies, their leadership, and staff.
 </li>
 <li>
 Inform pharmacists and their staff on patient access and affordability programs that could be beneficial to patients.
 </li>
 <li>
 Work with HCPs to support complete, accurate and timely prescription submissions to Network specialty pharmacies or health plans, to minimize delay in therapy.
 </li>
 <li>
 Serve as a Network Specialty Pharmacy partner within assigned geography and communicate with stakeholders in a timely manner.
 </li>
 <li>
 Maintain a strong working relationship with sales and sales leadership.
 </li>
 <li>
 Assist the Field Reimbursement and Patient Services Team in identifying opportunities for continuous process improvements through root cause analysis and identifying ongoing training needs.
 </li>
 <li>
 Conduct needs assessment and provides appropriate education for HCPs (i.e., CoverMyMeds, Prior Authorization (PA) process, pharmacy process).
 </li>
 <li>
 Coordinate cases with patient support service program representatives (HUB) to ensure patient and physician needs are being addressed in a timely manner.
 </li>
 <li>
 Educate physician office staff on the use of patient assistance programs and call center support services, including web-based provider programs.
 </li>
 <li>
 Attend POAs and Regional conference calls, providing education, training, and feedback on the positioning of our network pharmacies and the current market access environment, to ensure a clear path for HCP and the patient.
 </li>
 <li>
 Provide timely information on patient access to the National Account Directors so they are informed and up to date on pharmacy claims and PA process for PBMs and payers.
 </li>
 <li>
 Collaborate with the Field Reimbursement and Patient Services Team on patient cases that need additional support and training activities with network pharmacies.
 </li>
 <li>
 Maintain the highest level of ethical obligations and ensure that all activities are complied with applicable laws and regulations.
 </li>
 <li>
 When called on for business travel manage personal travel schedule and travel arrangements.
 </li>
 <li>
 Prepare and submit appropriate expense reports in a timely fashion.
 
 
 </li>
 </ul>
 
 Candidate Requirements:
 
 
 
 <ul>
 <li>
 Bachelor's degree preferred or Licensed / Certified Pharmacy Technician with at least 5+ years of experience; including work with a Pharmacy Benefit Manager, Health Plan, or healthcare provider's office, managing the prescription fulfillment process.
 </li>
 <li>
 Demonstrated working knowledge of pharmacy benefit design (Commercial, Medicare Part D, Medicaid, and prior authorization processes)
 </li>
 <li>
 Experience working with pharmacies and/or office-based physician practices preferred.
 </li>
 <li>
 Understand and comply with HIPAA rules and regulations related to patient privacy.
 </li>
 <li>
 Demonstrated ability to thrive in a dynamic, fast-paced environment with date sensitive deadlines. Identifying issues quickly and provide solutions.
 </li>
 <li>
 Strong interpersonal skills and the ability to develop strong working relationships and work collaboratively across cross-functional teams.
 </li>
 <li>
 Ability to deliver presentations with small and large groups.
 </li>
 <li>
 Strong written and oral communication skills; and excellent planning and organizational skills.
 </li>
 <li>
 Demonstrates strong attention to detail.
 </li>
 <li>
 Ability to work with data and quickly analyze trends and take appropriate action.
 </li>
 <li>
 Ability to work independently and within a team.
 
 
 </li>
 </ul>
 
 Additional Information:
 
 
 
 <li>
 Technology needs: Microsoft Office
 </li>
 Travel requirements (%): The average travel for this position is &lt;10% with some variation based upon the time of year and demands of the business imperatives. The travel requirements will vary based on the geography and account responsibilities for this position.
</div>

Pharmacy Experience Associate (Carolinas)

<div>Position Title: Pharmacy Experience Associate

Department: Commercial - Market Access
Reports To (title): Associate Director Field Reimbursement and Patient Services

Location: Remote - Carolinas (Charlotte preferred)
<ul><li>Exempt Non-Exempt
</li></ul>We are looking for resourceful, collaborative, passionate and purposeful professionals who want to be part of a fast-moving, entrepreneurial environment, where transformational patient solutions are developed!

Summary of Position:
The Pharmacy Experience Associate (PEx) interacts with both internal and external individuals to compliantly support patient access and affordability challenges. This individual has a strong understanding of the variety of patient services that are available and will work efficiently with Healthcare Professionals (HCPs) and pharmacies to support questions related to prescription fulfillment. The incumbent will assess training and education needs of Prescribers, medical office staff, and Pharmacists to support the accurate submission and fulfillment of future prescriptions for the appropriate patient. This individual understands patient access and payer related challenges as well as the complexity of the pharmacy and prescription process. The Pharmacy Experience Associate escalates more complicated cases to the Field Reimbursement and Patient Services Team. They work with a sense of urgency while focused on clear and succinct communication with all parties involved.

This role will be part of the Paratek Market Access team and will report to the Executive Director, Trade Relations, and Patient Services.

Position Responsibilities:
<ul><li>Utilizing data insights, identify prescriptions that are delayed or stalled and take appropriate action.</li>
<li>Establish, develop, and maintain working relationships with regional network specialty pharmacies, their leadership, and staff.</li>
<li>Inform pharmacists and their staff on patient access and affordability programs that could be beneficial to patients.</li>
<li>Work with HCPs to support complete, accurate and timely prescription submissions to Network specialty pharmacies or health plans, to minimize delay in therapy.</li>
<li>Serve as a Network Specialty Pharmacy partner within assigned geography and communicate with stakeholders in a timely manner.</li>
</ul><ul><li>Maintain a strong working relationship with sales and sales leadership.</li>
<li>Assist the Field Reimbursement and Patient Services Team in identifying opportunities for continuous process improvements through root cause analysis and identifying ongoing training needs.</li>
<li>Conduct needs assessment and provides appropriate education for HCPs (i.e., CoverMyMeds, Prior Authorization (PA) process, pharmacy process).</li>
<li>Coordinate cases with patient support service program representatives (HUB) to ensure patient and physician needs are being addressed in a timely manner.</li>
<li>Educate physician office staff on the use of patient assistance programs and call center support services, including web-based provider programs.</li>
<li>Attend POAs and Regional conference calls, providing education, training, and feedback on the positioning of our network pharmacies and the current market access environment, to ensure a clear path for HCP and the patient.</li>
<li>Provide timely information on patient access to the National Account Directors so they are informed and up to date on pharmacy claims and PA process for PBMs and payers.</li>
<li>Collaborate with the Field Reimbursement and Patient Services Team on patient cases that need additional support and training activities with network pharmacies.</li>
<li>Maintain the highest level of ethical obligations and ensure that all activities are complied with applicable laws and regulations.</li>
<li>When called on for business travel manage personal travel schedule and travel arrangements.</li>
<li>Prepare and submit appropriate expense reports in a timely fashion.</li>
</ul>
Candidate Requirements:
<ul>
<li>Bachelor&rsquo;s degree preferred or Licensed / Certified Pharmacy Technician with at least 5+ years of experience; including work with a Pharmacy Benefit Manager, Health Plan, or healthcare provider&rsquo;s office, managing the prescription fulfillment process.</li>
<li>Demonstrated working knowledge of pharmacy benefit design (Commercial, Medicare Part D, Medicaid, and prior authorization processes)</li>
</ul><ul><li>Experience working with pharmacies and/or office-based physician practices preferred.</li>
<li>Understand and comply with HIPAA rules and regulations related to patient privacy.</li>
<li>Demonstrated ability to thrive in a dynamic, fast-paced environment with date sensitive deadlines. Identifying issues quickly and provide solutions.</li>
<li>Strong interpersonal skills and the ability to develop strong working relationships and work collaboratively across cross-functional teams.</li>
<li>Ability to deliver presentations with small and large groups.</li>
<li>Strong written and oral communication skills; and excellent planning and organizational skills.</li>
<li>Demonstrates strong attention to detail.</li>
<li>Ability to work with data and quickly analyze trends and take appropriate action.</li>
<li>Ability to work independently and within a team.</li>
</ul>
Additional Information:
<ul>
<li>Technology needs: Microsoft Office</li>
<li>Travel requirements (%): The average travel for this position is &lt;10% with some variation based upon the time of year and demands of the business imperatives. The travel requirements will vary based on the geography and account responsibilities for this position.</li></ul></div>

MedOne Benefit Solutions

<div>Company Information
MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people access the right prescription at the best price.
Position Overview
The Director of Pricing is responsible for developing, governing, and optimizing pricing strategies across all MedOne services and clients. This role ensures pricing competitiveness, financial sustainability, and regulatory compliance while supporting sales growth and client retention. The Director will lead pricing strategy, analytics, and governance while serving as a key cross-functional partner.
Essential Job Functions<ul><li>
Direct, train, and mentor team members within the Pricing Department to ensure they are effectively performing in their responsibilities</li><li>
Lease strategic and manage administrative responsibilities related to pharmacy pricing, rebate contracting, client contracting, financial planning and analysis, and trend modeling.</li><li>
Manage the development and maintenance of policies and procedures specific to the Pricing Team.</li><li>
Elevate and maintain our standard pricing contractual language ensuring contracts align with underwriting assumptions</li><li>
Support negotiations between MedOne and clients or supply chain participants to deliver innovative approaches that expand MedOne&rsquo;s customer base</li><li>
Ensure MAC management and guarantee reconciliations for all lines of business are within acceptable performance thresholds</li><li>
Ensure we are meeting or exceeding client and supply chain expectations regarding pricing throughout the relationship lifecycle</li><li>
Assist in sales and client meetings as needed to help close new business and retain business, respectively</li><li>
Represent MedOne for all pricing related matters, both internally and externally</li><li>
Help develop new and improve existing relationships with channel partners and clients</li><li>
Lead periodic client and pharmacy reconciliations including an exchange of claims detail, analysis of claims detail and conference calls</li><li>
Ensure RFP responses for financial-related questions are complete, accurate, and maximize MedOne&rsquo;s position to be awarded new business while maintaining the desired levels of profitability</li><li>
Continuously engage in process analysis and problem solving to identify opportunities that can be addressed via automation tools and/or applications</li></ul>
Position Requirements<ul><li>
Bachelor&rsquo;s Degree in Finance, Math, Computer Science or related field</li><li>
8+ years of relevant PBM or Pharmacy Benefit Consulting experience</li><li>
Previous leadership experience with similar responsibilities</li><li>
Knowledge of PBM procurement, specialty pharmacy, PBM pricing and contracting</li><li>
Ability to prioritize and handle multiple projects and clients with dynamic and shifting timelines</li><li>
Demonstrated ability to manage relationships (client and vendor)</li><li>
Strong leadership skills with experience collaborating within teams to produce results</li><li>
Proven ability to work in a progressive, fast-paced environment</li><li>
Ability to travel periodically around 25%</li><li>
Must be eligible to work in the United States without need for work visa or residency sponsorship</li><li>
Must be under no restrictive non-compete covenant from a previous or existing employer</li></ul>
Work Hours | Location<ul><li>
This can be a remote position within the United States or be a hybrid position based in Dubuque, IA, or Overland Park, KS.</li><li>
Full-time, salaried position requiring 40 hours per week</li></ul>
 How to Apply: If you're enthusiastic about helping others and eager to join a dynamic team, we&rsquo;d love to hear from you. Apply now and take the first step toward a rewarding career at MedOne! You can submit your application through our careers page.
MedOne is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Job Offers are contingent on passing a background check and drug screen.</div>

Director of Pricing

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