pharmacy benefits coordinator

Optum

<div><p>Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start <b>Caring. Connecting. Growing together.</b></p><p>
Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.</p><p>
The <b>Senior Retail Medication</b> <b>Prior Authorization Coordinator</b> is responsible for reviewing and processing request for prior authorization of medication in accordance with insurance provider guidelines. This role requires a solid understanding of healthcare insurance policies, pharmacy benefit management, and medical terminology.
</p><p><b>Schedule: </b>Monday-Friday, 8am-5pm PST</p><p><b>
Location: </b>Onsite for training at 7600 Evergreen Way, Everett WA for about 1-3 month training period and then will become fully remote.</p><p>
Candidates must reside near Everett, WA or must be willing and able to commute to the Everett office at their own expense for training</p><p>
If you live near Everett, WA, you will enjoy the flexibility of a hybrid-remote position* as you take on some tough challenges.</p><p>
This position follows a hybrid schedule with three in-office days per week.</p><p><b>
Primary Responsibilities:</b></p><ul><li><p>
Acquire and maintain a working knowledge of health plan formulary and authorization requirements</p></li><li><p>
Utilize internal system to facilitate faster turnaround time on a complete authorization</p></li><li><p>
Gather necessary information from chart review to submit prior auth request to insurance providers</p></li><li><p>
Act as a liaison between providers, pharmacy, health plans and patients to support a timely medication authorization process</p></li><li><p>
Communicate with providers, pharmacy, and patients to provide updates on the status of their prior auth request</p></li><li><p>
Document in the patient electronic health record all medication authorization work provided following standard work guidelines</p></li><li><p>
Provide and document in Epic medication authorization denials and health plan recommendation and or alternatives when provided</p></li><li><p>
Ensure compliance with all relevant laws, regulations, and policies related to medication prior authorizations</p></li><li><p>
Performs other duties as assigned</p></li></ul><p><b>
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:</b></p><ul><li><p>
 Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays</p></li><li><p>
Medical Plan options along with participation in a Health Spending Account or a Health Saving account</p></li><li><p>
Dental, Vision, Life&amp; AD&amp;D Insurance along with Short-term disability and Long-Term Disability coverage</p></li><li><p>
401(k) Savings Plan, Employee Stock Purchase Plan</p></li><li><p>
Education Reimbursement</p></li><li><p>
Employee Discounts</p></li><li><p>
Employee Assistance Program</p></li><li><p>
Employee Referral Bonus Program</p></li><li><p>
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)</p></li><li><p>
More information can be downloaded at: http://uhg.hr/uhgbenefits</p></li></ul><p>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.</p><div><b>
Required Qualifications:</b></div><ul><li><div>
High School Diploma/GED (or higher)</div></li><li><div>
1+ years of Pharmacy Technician or a Medical Assistant experience OR 1+ years of experience in a pharmacy setting</div></li><li><div>
1+ years of experience with basic computer software and keyboarding</div></li><li><div>
Must reside within a commutable distance to Everett and surrounding communities in Washington</div></li><li><div>
Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)</div></li><li><div>
Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service</div></li></ul><div><b>
Preferred Qualifications:</b></div><ul><li><div>
Current certification from WA State Department of Health as a Certified Medical Assistant or WA State Pharmacy Technician License</div></li><li><div>
Knowledge of EMR (EPIC)</div></li><li><div>
Proficiency with keyboarding, documentation, and processing prior authorizations</div></li></ul><div><b>
Soft Skills:</b></div><ul><li><div>
Ability to work independently and maintain good judgment and accountability</div></li><li><div>
Demonstrated ability to work well with health care team</div></li><li><div>
Strong organizational and time management skills</div></li><li><div>
Ability to multi-task and prioritize tasks to meet all deadlines</div></li><li><div>
Ability to work well under pressure in a fast-paced environment</div></li><li><div>
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others</div></li><li>All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul><div><br>
</div><div></div><div>Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.</div><div></div><div><br>
</div><p><i>At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.</i></p><div></div><div><br>
</div><div></div><div><i>UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.</i></div><div></div><div><i><br>
</i></div><div></div><div><i>UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.</i></div><div></div><div><i><br>
</i></div><div></div><div>#RPO, #YELLOW</div></div><p></p>

Senior Retail Medication Prior Authorization Coordinator

Manpower

<p>Our client is seeking an experienced <b>Pharmacy Claims &amp; Benefits Specialist</b> to support members, providers, and insurance carriers by verifying eligibility, resolving prescription issues, and ensuring accurate claims processing in a fast-paced pharmacy environment.</p><p>Schedule</p><ul><li>Monday &ndash; Friday | 11:30 AM &ndash; 8:00 PM</li><li>Occasional Saturdays &amp; required overtime</li><li>Remote role with potential <b>1&ndash;2 days onsite in Plymouth, MI</b></li></ul><p>Key Responsibilities</p><ul><li>Verify insurance eligibility and prescription benefits</li><li>Process prescriptions and support claims adjudication</li><li>Communicate with providers, payers, pharmacies, and members to resolve billing or prescription issues</li><li>Coordinate with PBMs and pharmacists</li><li>Maintain accurate documentation and meet productivity/quality goals</li><li>Escalate complex issues as needed</li></ul><p>Qualifications</p><ul><li>High School Diploma required; degree preferred</li><li>Active CPhT or Registered Pharmacy Technician license</li><li>1-2 years of pharmacy experience</li><li>Experience with claims adjudication, Medicaid, secondary billing, or discount cards preferred</li><li>Strong communication, attention to detail, and ability to work in a high-volume environment</li><li>Proficiency in Microsoft Office and pharmacy systems</li></ul><p>Pay: $20.50 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Referral program</li></ul><p>Work Location: Hybrid remote in Plymouth, MI 48170</p>

Pharmacy Claims & Benefits Specialist

Henry Ford Health

<div><div><p>Join the growing <b>Henry Ford Health Pharmacy Advantage</b> team as a <b>Full-Time Pharmacy Benefits Specialist!</b> Make a meaningful impact on patient care while enjoying a <b>flexible hybrid schedule</b> (In-person + Remote). This role offers a <b>$2,500 sign-on bonus</b> and <b>comprehensive full-time benefits</b>. You'll support patients and providers by helping navigate pharmacy benefits and coordinating prescription services. Be part of a mission-driven team that's improving lives every day! This role is based out of Rochester Hills close door Pharmacy department here at Henry Ford Health.</p><p><b>
GENERAL SUMMARY:</b></p><p>
***Eligible for $2,500 Sign on Bonus***</p><p>
Location: Rochester Hills, MI</p><p>
Schedule: Full- Time Day Shifts</p><p>
In this role, you will collaborate with our Specialty Department within the Henry Ford Health Pharmacy Advantage Team.</p><p><b>
Specialty Department: </b>The Pharmacy Benefits Specialist within the Specialty Department provides patient-centered services for specialty medications. Responsibilities include prescription intake, insurance benefits investigation, prior authorization management, financial assistance support, refill adherence, and delivery coordination. Team members collaborate closely with patients, providers, and insurers to navigate the specialty medication process, ensuring timely care and a positive patient experience. This office-based role requires strong computer and phone communication skills. We are looking for dedicated, compassionate individuals ready to join a collaborative, quality-focused team committed to patient success.</p><p></p><p><i><br>
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.</i></p>
<div><p><b>EDUCATION/EXPERIENCE REQUIRED:</b></p><ul><li>
Requires a High school diploma or G.E.D. Associates degree preferred</li><li>
Requires State of Michigan Pharmacy Technician License.</li><li>
Requires a minimum of two years of previous pharmacy technician experience.</li><li>
Previous experience as a specialty pharmacy technician preferred.</li></ul>
 </div></div><div><div><div><div><h4 class="jobSectionHeader"><b>Additional Details</b></h4>
<div><p>
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.</p></div>
</div>
</div></div><div><div><div><h4 class="jobSectionHeader"><b>Overview</b></h4>
<div><p>
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services &ndash; from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford&rsquo;s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation&rsquo;s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.</p></div>
</div>
</div></div><div><div><div><h4 class="jobSectionHeader"><b>Benefits</b></h4><div><p><br>
</p><p>The health and overall well-being of our team members is our priority. That&rsquo;s why we offer support in the various components of our team&rsquo;s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
</p></div></div></div></div><div><div><div><h4 class="jobSectionHeader"><b>Equal Employment Opportunity/Affirmative Action Employer</b></h4>
<div><p>
 Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is</p>
<p>
 committed to the hiring, advancement and fair treatment of all individuals without regard to</p>
<p>
 race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,</p>
<p>
 weight, marital status, family status, gender identity, sexual orientation, and genetic information,</p>
<p>
 or any other protected status in accordance with applicable federal and state laws.</p></div></div></div></div></div></div>

Pharmacy Benefits Specialist - Specialty - Full Time Days - Pharmacy Advantage

Curative, Inc.

<div><div><b>About Curative</b></div><div>
Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent <b>$150M in Series B funding </b>and valuation at <b>$1.275B</b>, Curative is scaling rapidly and investing in AI-powered service, deeper member engagement, and a smart network designed for today&rsquo;s workforce.</div><div></div><div><br>
Our north star guides everything we do: <b>healthcare only works when people can actually use it</b>. That belief drives every decision we make: from how we design our plan, support our members, to how we collaborate as a team.</div><div></div><div><br>
If you want to do meaningful work with a team that moves fast, experiments boldly, and cares deeply, Curative is the place to do it. We&rsquo;re growing fast and looking for teammates who want to help transform health insurance for the better.</div><div></div><div><b><br>
SUMMARY</b></div><div><br>
Curative wants to change the view on what a health plan can be. Born out of the pandemic, we created a health plan reinvented for a post-pandemic world that is built around whole-person affordable preventive care featuring more benefits. Curative is looking for a Pharmacy Technician with Member Services experience who is passionate about helping the company as we work to reinvent healthcare options. Candidates will be able to utilize their previous experience in Pharmacy Operations/Member Services experience by increasing satisfaction and retention by providing Curative health plan Members, patients, and providers with accurate, consistent, timely and meaningful information. They will provide support to Members&rsquo; while building rapport and collaborative relationships with current and prospective Members in accordance with compliance guidelines. This is a remote position with multiple shift options in a 24/7 call center.</div><div></div><div><b><br>
ESSENTIAL DUTIES AND RESPONSIBILITIES</b></div><ul><li>
Monitoring for prescription claims rejections from 3rd party pharmacies</li><li>
Outreach to members and providers with information regarding rejection and offering alternative options as applicable</li><li>
Working with the Curative pharmacy prior authorization team discussing PA decisions with members and providers as needed</li><li>
Evaluating extenuating requests and processing overrides as appropriate in the CAPRx JUDI system</li><li>
Working with the Pharmacy team on non formulary drug alternatives for member and provider notification</li><li>
Contact 3rd party pharmacies to reprocess claims, notify of drug alternatives, prior authorization status.</li><li>
Correct claims and prior authorization request as needed</li><li>
SME on pharmacy and drug benefits handling escalated contacts from members, providers, pharmacies, and member service team</li><li>
Escalation support for after hours issues resolution as needed</li><li>
Processing notifications to members services team for member outreach and status updates on prescription status</li><li>
Working with leadership team on policy and process improvements</li><li>
This position assumes and performs other duties, project management and data reporting as assigned</li><li>
Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).</li></ul><div></div><div><b><br>
QUALIFICATIONS</b><br>
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:</div><br>
<div></div><ul><li>
Excellent attendance is critical to success in this position</li><li>
Internal candidates must have been in their current role for at least 6 months and have no performance or attendance actions in effect.</li><li>
Excellent computer and phone skills, attention to detail, process and policy adherence</li><li>
Call Center Experience preferred but not required</li><li>
Excellent verbal and written communication skills.</li><li>
Strong interpersonal skills.</li><li>
Active listening skills to accurately respond to inquiries and requests.</li><li>
Exceptional organizational skills, retention of policy and process a must</li><li>
Intermediate skills minimum in google and microsoft office suite of products a must</li><li>
Experience with Talkdesk (or other VOIP phone systems) preferred but not required</li><li>
Experience with Helpscout (or other email ticket systems) preferred but not required</li><li>
Experience with JUDI (or other prescription claims systems) preferred but not required</li><li>
Experience with slack, gmail, zoom conference preferred but not required</li></ul><p><b>
EDUCATION and/or EXPERIENCE</b></p><ul><li>
Minimum 5 years experience in pharmacy or PBM operations</li><li>
Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.</li></ul><p><b>
CERTIFICATES, LICENSES, REGISTRATIONS</b></p><ul><li>
 Active PTCB certification required</li></ul><p><b>
WORK ENVIRONMENT</b><br>
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p><ul><li>
Remote position</li><li>
Must have a quiet place, secure, with no distractions to perform duties for work from home</li><li>
Must have password protected, stable internet access - stipend will be provided</li><li>
Work location MUST be secure and private to maintain HIPAA compliance for work from home</li><li>
Office equipment will be supplied including: PC, monitor, keyboard, mouse, headset</li><li>
While performing the duties of this Job, the employee is regularly required to sit; use hands to type, talk; and hear.</li><li>
The employee is frequently required to reach with hands and arms.</li><li>
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.</li><li>
We also request, with the exception of emergencies, that you do not request any time off within the first 120 days of employment. Any request within the first 120 days if approved will be unpaid</li><li>
For this position the percentage of expected Travel is:0% of the time</li></ul><div><b>
TRAINING EXPECTATIONS</b></div><br>
<div></div><ul><li>
You will attend a 2-3 week minimum remote training program.</li><li>
Attendance is mandatory for the full training program</li><li>
You will be required to take daily competency exams and a retention exam on the Friday of both weeks of training. Passing grades are 90% or above.</li><li>
We also request, with the exception of emergencies, that you do not request any time off within the first<br>
120 days of employment. Any request within the first 120 days if approved will be unpaid</li></ul><div></div><div><b><br>
Perks &amp; Benefits</b></div><div></div><ul><li><div><br>
Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)</div><ul><li><div>
$0 copays and $0 deductibles (with completion of our Baseline Visit )</div></li><li><div>
Preventive and primary care built in</div></li><li><div>
Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)</div></li><li><div>
One-on-one care navigation</div></li><li><div>
Chronic condition programs (diabetes, weight, hypertension)</div></li><li><div>
Maternity and family planning support</div></li><li><div>
24/7/365 Curative Telehealth</div></li><li><div>
Pharmacy benefits</div></li></ul></li><li><div>
Comprehensive dental and vision coverage</div></li><li><div>
Employer-provided life and disability coverage with additional supplemental options</div></li><li><div>
Flexible spending accounts</div></li><li><div>
Flexible work options: remote and in-person opportunities</div></li><li><div>
Generous PTO policy plus 11 paid annual company holidays</div></li><li><div>
401K for full-time employees</div></li><li><div>
Generous Up to 8&ndash;12 weeks paid parental leave, based on role eligibility.</div></li></ul></div><div></div>

Pharmacy Technician - Member Services

Curative

<div>
 <strong>
  About Curative
  <br/>
  <br/>
 </strong>
 Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent
 <strong>
  $150M in Series B funding
 </strong>
 and valuation at
 <strong>
  $1.275B
 </strong>
 , Curative is scaling rapidly and investing in AI-powered service, deeper member engagement, and a smart network designed for today&rsquo;s workforce.
 <br/>
 <br/>
 Our north star guides everything we do:
 <strong>
  healthcare only works when people can actually use it
 </strong>
 . That belief drives every decision we make: from how we design our plan, support our members, to how we collaborate as a team.
 <br/>
 <br/>
 If you want to do meaningful work with a team that moves fast, experiments boldly, and cares deeply, Curative is the place to do it. We&rsquo;re growing fast and looking for teammates who want to help transform health insurance for the better.
 <br/>
 <br/>
 <strong>
  Summary
  <br/>
  <br/>
 </strong>
 Curative wants to change the view on what a health plan can be. Born out of the pandemic, we created a health plan reinvented for a post-pandemic world that is built around whole-person affordable preventive care featuring more benefits. Curative is looking for a Pharmacy Technician with Member Services experience who is passionate about helping the company as we work to reinvent healthcare options. Candidates will be able to utilize their previous experience in Pharmacy Operations/Member Services experience by increasing satisfaction and retention by providing Curative health plan Members, patients, and providers with accurate, consistent, timely and meaningful information. They will provide support to Members&rsquo; while building rapport and collaborative relationships with current and prospective Members in accordance with compliance guidelines. This is a remote position with multiple shift options in a 24/7 call center.
 <br/>
 <br/>
 <strong>
  Essential Duties And Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Monitoring for prescription claims rejections from 3rd party pharmacies
  </li>
  <li>
   Outreach to members and providers with information regarding rejection and offering alternative options as applicable
  </li>
  <li>
   Working with the Curative pharmacy prior authorization team discussing PA decisions with members and providers as needed
  </li>
  <li>
   Evaluating extenuating requests and processing overrides as appropriate in the CAPRx JUDI system
  </li>
  <li>
   Working with the Pharmacy team on non formulary drug alternatives for member and provider notification
  </li>
  <li>
   Contact 3rd party pharmacies to reprocess claims, notify of drug alternatives, prior authorization status.
  </li>
  <li>
   Correct claims and prior authorization request as needed
  </li>
  <li>
   SME on pharmacy and drug benefits handling escalated contacts from members, providers, pharmacies, and member service team
  </li>
  <li>
   Escalation support for after hours issues resolution as needed
  </li>
  <li>
   Processing notifications to members services team for member outreach and status updates on prescription status
  </li>
  <li>
   Working with leadership team on policy and process improvements
  </li>
  <li>
   This position assumes and performs other duties, project management and data reporting as assigned
  </li>
  <li>
   Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
 <br/>
 <br/>
 <ul>
  <li>
   Excellent attendance is critical to success in this position
  </li>
  <li>
   Internal candidates must have been in their current role for at least 6 months and have no performance or attendance actions in effect.
  </li>
  <li>
   Excellent computer and phone skills, attention to detail, process and policy adherence
  </li>
  <li>
   Call Center Experience preferred but not required
  </li>
  <li>
   Excellent verbal and written communication skills.
  </li>
  <li>
   Strong interpersonal skills.
  </li>
  <li>
   Active listening skills to accurately respond to inquiries and requests.
  </li>
  <li>
   Exceptional organizational skills, retention of policy and process a must
  </li>
  <li>
   Intermediate skills minimum in google and microsoft office suite of products a must
  </li>
  <li>
   Experience with Talkdesk (or other VOIP phone systems) preferred but not required
  </li>
  <li>
   Experience with Helpscout (or other email ticket systems) preferred but not required
  </li>
  <li>
   Experience with JUDI (or other prescription claims systems) preferred but not required
  </li>
  <li>
   Experience with slack, gmail, zoom conference preferred but not required
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  EDUCATION And/or EXPERIENCE
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Minimum 5 years experience in pharmacy or PBM operations
  </li>
  <li>
   Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  CERTIFICATES, LICENSES, REGISTRATIONS
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Active PTCB certification required
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  WORK ENVIRONMENT
  <br/>
  <br/>
 </strong>
 The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 <br/>
 <br/>
 <ul>
  <li>
   Remote position
  </li>
  <li>
   Must have a quiet place, secure, with no distractions to perform duties for work from home
  </li>
  <li>
   Must have password protected, stable internet access - stipend will be provided
  </li>
  <li>
   Work location MUST be secure and private to maintain HIPAA compliance for work from home
  </li>
  <li>
   Office equipment will be supplied including: PC, monitor, keyboard, mouse, headset
  </li>
  <li>
   While performing the duties of this Job, the employee is regularly required to sit; use hands to type, talk; and hear.
  </li>
  <li>
   The employee is frequently required to reach with hands and arms.
  </li>
  <li>
   Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
  </li>
  <li>
   We also request, with the exception of emergencies, that you do not request any time off within the first 120 days of employment. Any request within the first 120 days if approved will be unpaid
  </li>
  <li>
   For this position the percentage of expected Travel is:0% of the time
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  TRAINING EXPECTATIONS
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   You will attend a 2-3 week minimum remote training program.
  </li>
  <li>
   Attendance is mandatory for the full training program
  </li>
  <li>
   You will be required to take daily competency exams and a retention exam on the Friday of both weeks of training. Passing grades are 90% or above.
  </li>
  <li>
   We also request, with the exception of emergencies, that you do not request any time off within the first 120 days of employment. Any request within the first 120 days if approved will be unpaid
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Perks &amp; Benefits
 </strong>
 <br/>
 <br/>
 <ul>
  <li>
   Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
  </li>
  <ul>
   <li>
    $0 copays and $0 deductibles (with completion of our Baseline Visit )
   </li>
   <li>
    Preventive and primary care built in
   </li>
   <li>
    Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)
   </li>
   <li>
    One-on-one care navigation
   </li>
   <li>
    Chronic condition programs (diabetes, weight, hypertension)
   </li>
   <li>
    Maternity and family planning support
   </li>
   <li>
    24/7/365 Curative Telehealth
   </li>
   <li>
    Pharmacy benefits
   </li>
  </ul>
  <li>
   Comprehensive dental and vision coverage
  </li>
  <li>
   Employer-provided life and disability coverage with additional supplemental options
  </li>
  <li>
   Flexible spending accounts
  </li>
  <li>
   Flexible work options: remote and in-person opportunities
  </li>
  <li>
   Generous PTO policy plus 11 paid annual company holidays
  </li>
  <li>
   401K for full-time employees
  </li>
  <li>
   Generous Up to 8&ndash;12 weeks paid parental leave, based on role eligibility.
  </li>
 </ul>
</div>


EmblemHealth

<div></div><div><div>Summary of Job</div><div>
Support eligibility and benefits configuration and deployment, including collaboration with pharmacy benefits manager (PBM) and Cognizant, formulary teams, for configuration. Responsible for Quality Assurance and Testing for operations and implementations. Coordinate and manage the pharmacy plan/ benefit design implementation process in partnership with PBM to ensure the accuracy and timeliness of members&rsquo; pharmacy benefit administration for superior member experience.</div><div>
Responsibilities</div><ul><li>
Maintain in-depth understanding of and ability to create and maintain plan/benefit design rules and limitations to include: Adjudication rules, Clinical rules, Payment rules, and Plan/group management.<br>
</li><li>
Partner with Sales and Product teams, assist in developing pharmacy benefit plan designs, meeting client requests, Health Plan strategic/ business parameters and all regulatory and other oversight agencies&rsquo; requirements.<br>
</li><li>
Responsible for creating and maintaining plan/benefit design documentation to support internal and external requirements<br>
</li><li>
Lead communication and coordination between Health Plan and PBM for receipt of required information for claims adjudication system set up, reporting and claim adjudication process.<br>
</li><li>
Assess all requests for new/ changes to plan benefit information to ensure compatibility with PBM claim adjudication logic.<br>
</li><li>
Submit accurate and complete requests to the PBM for new and changing benefit plan designs.<br>
</li><li>
Test pharmacy benefit plan designs for accuracy and alignment with business requirements.<br>
</li><li>
Serve as liaison to PBM to troubleshoot and resolve benefit-related questions/ issues, researching plan/benefit design options and requirements.<br>
</li><li>
Participate in PBM implementation meetings as required.<br>
</li><li>
Review and approve PBM benefit set up requirements.<br>
</li><li>
Perform claim testing to ensure accurate claim adjudication.<br>
</li><li>
Work with the pharmacy clinical team to implement formulary updates in the claim adjudication system.<br>
</li><li>
Participate in the research and resolution of claims adjudication-related discrepancies, errors, and problems.<br>
</li><li>
Acts as a resource to operational areas in support of the pharmacy claims adjudication process and responding to issues related to plan/ benefit design.<br>
</li><li>
Conduct quarterly audits of pharmacy benefit configurations to ensure alignment with plan design, regulatory requirements, and accurate claim adjudication across all lines of business.<br>
</li><li>
Recommend streamlined work processes and systems that impact plan/ benefit design to create efficiency and quality outcomes.<br>
</li><li>
Maintain acceptable and appropriate quality levels and production SLA response time.<br>
</li><li>
Perform other projects and duties as assigned</li></ul>
<div><div>Qualifications</div><ul><li>
Bachelor&rsquo;s degree.<br>
</li><li>
Pharmacy Technician Certification (Required)<br>
</li><li>
Additional years of related experience may be considered in lieu of degree (Required)<br>
</li><li>
Ability to perform in office environment with extended periods of sitting, using telephone, and viewing computer screens (Required)<br>
</li><li>
Ability to prioritize tasks daily and trouble shoot urgent customer issues to successful completion (Required)<br>
</li><li>
Advanced knowledge of MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)<br>
</li><li>
Exceptional problem solving, analytical, interpersonal and communication skills to resolve issues within Operations (Required)<br>
</li><li>
Professionally skilled in verbal and written communication (Required)<br>
</li><li>
Meticulous organization skills, with the ability to multi-task, and ability to make sound decisions in a timely and independent manner (Required)</li></ul>
</div><div><p>Additional Information
</p><ul><li>Requisition ID: 1000003022</li>
<li>Hiring Range: $56,160-$99,360</li></ul></div></div>

Pharmacy Benefits Operations Specialist - Remote

Onco360

<div><div><b>Join a mission-driven team making a difference in the lives of cancer patients.</b></div>
<div></div><div><b>Patient Financial Advocacy Coordinator &ndash; Onco360 Pharmacy</b><br>
<b><i>Buffalo, NY </i></b><b>| </b><b><i>Full-Time</i></b><b> | </b><b><i>Mon - Fri 11:30am to 8pm EST</i></b></div>
<div><b><i>Salary</i></b><b> </b><b><i>Starting at $23.00/hr and up</i></b></div>
<div></div><div>Onco360, a leading oncology pharmacy, is seeking a <b>Patient Financial Advocacy Coordinator. C</b>andidate to live within commuting distance of our Buffalo pharmacy. <b>Remote work possible after initial on-site training.</b></div>
<div></div><div><b>Company Benefits</b></div>
<ul><li>Medical; Dental; Vision</li>
<li>401k opportunity</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Quarterly Incentive Bonus</li>
<li>Paid Volunteer Day</li>
<li>Referral Incentive Program</li>
<li>Company Paid Life Insurance; and Short/Long-Term Disability</li>
</ul> <p></p><div><b>Why Join Us?</b></div>
<ul><li>A career with purpose: Help patients access life-saving medications.</li>
<li>Supportive culture: We value <b>teamwork, respect, integrity, and passion</b>.</li>
<li>Growth opportunities: We invest in your professional and personal development.</li>
</ul><p></p><div><b>What You&rsquo;ll Do</b></div>
 <div>The <b>Patient Advocacy Coordinator</b> is responsible for assisting patients and/or families to access financial resources for Pharmacy co-pays. The Advocacy Coordinator assists patients who may qualify for assistance through Not for Profit Organizations and Manufacturer Programs. They are responsible for navigating the system to find resources that best fits the patient&rsquo;s needs, aid patients by explaining the process, assist in filling out applications and going over the documents that will be required to complete the application.</div>
<div></div><div><b>How You&rsquo;ll Do This</b></div>
<ul><li>Practice first call resolution to assist patients and families in securing financial assistance for pharmacy co-pays.</li>
<li>Maintain a working knowledge of health insurance and pharmacy benefit coverage, cancer diagnoses and drugs used in their treatment.</li>
<li>Support applications for nonprofit and manufacturer assistance programs.</li>
<li>Provide clear explanations of insurance benefits and co-pay structures.</li>
<li>Maintain accurate patient demographic and insurance data in CPR+.</li>
<li>Collaborate with pharmacy operations and cross-functional teams to ensure seamless service.</li>
</ul> <p></p><div><b>What You Bring</b></div>
<div><b>Required:</b></div>
<ul><li>High School Diploma or GED</li>
<li>1+ years of patient assistance or advocacy experience</li>
<li>Registration with Board of Pharmacy (as required by state law)</li>
<li>Strong communication, organizational, and customer service skills</li>
</ul><div><b>Preferred:</b></div>
<ul><li>Associate degree or Certified Pharmacy Technician (PTCB)</li>
<li>3+ years of patient assistance or advocacy experience</li>
<li>Specialty pharmacy experience</li>
</ul><p></p><div><b>Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.</b></div></div>

Patient Assistance Program / Financial Advocacy Coordinator

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