Develop and implement programs that benefit clients.
Manage pharmacy service provider relationships.
EPIC is a company with over 60 offices and 3,000 employees nationwide which embraces diversity in all its various forms. They foster a work community where every colleague feels welcomed, valued, respected and heard, believing that diversity drives innovation.
Collaborate with clinic teams to deliver hands-on patient care.
Process prior authorizations, resolve insurance issues, and support financial assistance.
Educate patients on pharmacy services and assist with specialty and retail prescriptions.
Shields Health Solutions is redefining patient care through specialty pharmacy. They are hiring motivated people and seem to have a good employee culture.
Develop and maintain a quality audit program for the Clinical Review Team.
Ensure high-quality reviews and adherence to regulatory requirements.
Deliver exceptional member, provider, and employee experiences.
SmithRx is a rapidly growing Health-Tech company that aims to disrupt the Pharmacy Benefit Management (PBM) sector using technology and customer service. The company has a mission-driven and collaborative culture, with hundreds of thousands of members onboarded since 2016.
Works in the build, implementation, and maintenance of automation and technology to optimize pharmacy practice, pharmacy systems, and the medication‐use process.
Responsible for effective process design, development, and implementation of Electronic Medical Record and Clinical Decision Support build.
Implements and optimizes the use of technology and the electronic health record to enhance the entire medication use process using both clinical, informatics and leadership skills.
Legacy Health is focused on good health for their people, patients, communities, and the world, and committed to doing the right thing. They foster an inclusive environment where everyone can grow and succeed.
Communicate with insurance companies to facilitate medication approvals.
Navigate pharmacy systems to input data and prepare action plans.
Communicate with patients and clinician offices regarding medication access.
Shields Health Solutions focuses on improving patient care by removing barriers to medication access. They value creating a positive and inclusive work environment where employees can grow their careers.
Review patient care notes for clinical data needed for prior authorization approvals.
Monitor patient adherence across all sites and disease categories, focusing on oncology and specialty-specific disease states.
Recommend alternative therapeutic drug regimens and disease-specific treatments according to guidelines.
Shields Health Solutions provides integrated pharmacy solutions to health systems. They focus on improving patient care and outcomes through specialized pharmacy programs and services. The company values innovation, collaboration, and a patient-centered approach.
Develops workflows, protocols, and policies that support efficient and compliant TOC operations.
Provides leadership and supervision to designated groups of employees including assurance of quality service delivered by a competent staff to consistently meet the needs of the hospital patients.
Develop, implement, and continuously improve TOC pharmacy programs aligned with organizational goals and regulatory requirements.
Baptist Health is a full-spectrum health system dedicated to improving the health of the communities it serves. The Baptist Health family consists of 10 hospitals, employed and independent physicians, and more than 470 points of care and employs more than 24,000 people in Kentucky and surrounding states.
Serve as lead program manager for Enterprise Drug File Adoption, with oversight of drug file content, training, education, and adoption activities across VA sites
Lead preparation, transition, and sustainment of the Cerner drug file, including oversight of the drug file component of VA site prescription migration
Act as primary liaison with VA Medical Centers (VAMCs) on VistA and Cerner, helping sites identify and resolve drug file discrepancies prior to and following Go-Live
Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations and enhanced service delivery. They are based in Alexandria, Virginia, support more than a dozen agencies and have 300+ employees nationwide.
Provide comprehensive medication management, including reconciliation, dose optimization, adherence support, and drug‑level assessments aligned with evidence‑based standards.
Partner with physicians, specialists, and interdisciplinary teams to order individualized care plans under a CPA and promote seamless medication coordination.
Monitor therapy effectiveness and safety, identify optimization and intervene as appropriate.
Shields Health Solutions is redefining patient care through health-system integrated specialty pharmacy. They are known for elevating patient care at nationally recognized Academic Medical Centers and building meaningful relationships with patients and providers.
Partner with payer clients as a trusted clinical advisor to design drug management strategies.
Assess and benchmark PBM and other industry vendor clinical programs.
Leverage medical and pharmacy data to assess program performance.
PSG (Pharmaceutical Strategies Group), an EPIC owned company, provides consultative guidance to payer clients in the drug management market. They have over 3,000 employees nationwide and foster a 50/50 culture between producers and the rest of the business, supporting collaboration and teamwork.
Evaluates certification requests by reviewing the group specific requirements.
Triage the call to determine if a Utilization Review Nurse is needed to complete the call.
Cottingham & Butler sells a promise to help their clients through life’s toughest moments. Their culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.
Develop and implement region-level strategies for pharmacy compliance, revenue cycle, data management, technology, financial planning, and operational improvement.
Manage, improve, and develop pharmacy business and operational functions to enhance compliance, revenue cycle, data integrity, and medication-related technology implementation.
Lead, plan, direct, and coordinate business operations, fostering effective working relationships with internal and external stakeholders.
CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually.
Review medication orders for accuracy and safety, providing patient counseling.
Collaborate with healthcare providers, monitor drug interactions, and maintain records.
Ensure regulatory compliance, contribute to protocol development, and assist in training.
Shields Health Solutions provides pharmaceutical care services to patients, collaborating with healthcare professionals . They focus on safe and effective medication therapies.
Be the primary face to the client during the implementation process
Conduct impact analysis with client to determine the appropriate requirements for a smooth and successful implementation
Create and maintain a detailed project plan and open items log for project monitoring purposes
SmithRx is a rapidly growing Health-Tech company aiming to disrupt the Pharmacy Benefit Management (PBM) sector. They have a mission-driven and collaborative culture that inspires their employees to do their best work and are guided by their company values: Integrity, Courage, and Together.
Manage a caseload and deliver exemplary member-centric care as part of the interdisciplinary team.
Deliver coaching and mentoring for quality improvement, best practices, and help drive performance.
Transcarent is the One Place for Health and Care, bringing medical, pharmacy, and point solutions together. More than 1,700 employers and health plans rely on them to provide information, guidance, and care, empowering health consumers with more choice and higher-quality care.
Assess referred concurrent denials and determine next steps for resolution.
Review medical record documentation to support denial management strategies.
Advocate for patients to ensure coverage and reimbursement.
They are currently looking for a Utilization Management Coordinator. By enhancing operational efficiencies and implementing educational initiatives, this role significantly impacts the financial and quality outcomes of healthcare delivery.
Create innovative clinical programs, products, and services aimed at optimizing specialty and non-specialty drug management, support payer clients with their PBM and drug coverage decisions
Act as a detail-oriented advisor, using data-driven insights to evaluate pharmacy programs, identify trend drivers, outlier high-cost claims and drive improvements.
Monitor emerging market trends and drug pipelines to anticipate client impact and develop proactive solutions.
Pharmaceutical Strategies Group (PSG), an EPIC owned company, provides an integrated data and analytics platform that transforms member data into actionable intelligence, which drives improved management of drug spend and trend across both pharmacy and medical benefits. EPIC has over 60 offices and 3,000 employees nationwide.
Build and lead Zócalo Health’s prior authorization function.
Design and implement scalable processes for authorization intake, submission, tracking, and follow up.
Hire, develop, and manage a team responsible for authorization operations.
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all healthcare system. Founded in 2021, Zócalo Health is backed by leading healthcare and mission-aligned investors and is scaling rapidly across states and populations.
Definium Therapeutics, formerly known as Mind Medicine, is a clinical stage biopharmaceutical company developing novel product candidates to treat brain health disorders. Founded in 2019, they are continuously expanding their presence and global footprint and searching for high-impact individuals to strengthen their team.
Manage team members in benefit configuration and testing.
Improve processes and institute best practices in benefit configuration.
Build and maintain pharmacy benefit plans for client groups.
SmithRx is a rapidly growing Health-Tech company disrupting the Pharmacy Benefit Management (PBM) sector. They focus on building a next-generation drug acquisition platform with technology, cost-saving tools, and customer service, fostering a mission-driven and collaborative culture.