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.
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.
Responsible for being the main point of contact for TPA (an external client) for new group implementations.
Ensure all requirements are documented in the standard project templates and tools.
Manage day to day coordination and task managements for a pod of Implementation Managers and/or Implementation Specialists to maintain workplace productivity.
SmithRx is a rapidly growing, venture-backed Health-Tech company aiming to disrupt the Pharmacy Benefit Management (PBM) sector. They accomplish this through technology and customer service, with a mission-driven and collaborative culture that inspires employees.
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.
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.
Lead and nurture a dynamic team of clinical pharmacists and technicians.
Create and uphold robust policies and procedures for utilization management review.
Generate and deliver comprehensive reports on prior authorization metrics.
Judi Health is an enterprise health technology company providing solutions for employers and health plans, including pharmacy benefit management and health benefit management. Judi Health values diversity and provides equal employment opportunities to all employees and applicants.
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.
Responsible for planning and executing quality and oversight activities to ensure operational compliance.
Responsible for internal and external case audits for Capital and our delegated UM vendors.
Responsible for educating staff on findings, and the audit tool ensuring a consistent approach.
Capital Blue Cross promises to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
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.
You will function as a central knowledge holder in a specialized team within Pharma Regulations & Audits.
You will carry out audits and compliance checks, formulate improvement measures and supervise the implementation.
You will implement projects to improve compliance and quality processes.
Redcare Pharmacy is Europe’s leading online pharmacy driven by innovative technologies and the passion of its employees. The company strives for an inspiring and collaborative work environment where everyone feels valued and contributes to their mission: “Until every human has their health.”
Work with internal and external teams to ensure pharmacies meet accreditation requirements.
Assist with staff training and process implementation related to meeting accreditation standards.
Prepare reports and maintain records, and participate in internal/external meetings.
VytlOne (formerly Maxor National Pharmacy Services) is a leading, independent pharmacy solutions platform that improves prescription drug affordability and outcomes. With a workforce of 1,600+ and almost a century of pharmacy experience, they offer the stability of a Fortune 500 company and the energy and innovation of a startup.
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.
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.
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.
Conducts audits of clinical documentation reviews to ensure compliance and regulatory requirements.
Develop and deliver training sessions based on audit findings to support CDI team competency.
Oversee the accuracy, specificity, and completeness of clinical documentation.
Adventist HealthCare is a faith-based, not-for-profit organization dedicated to improving the health and well-being of people and communities. They employ over 6,000 professionals and are one of the longest serving healthcare systems in the Washington, D.C., area.
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.
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.
Conduct routine patient check‑ins to monitor therapy experience, identify concerns, and support adherence to treatment plans.
Assist with initial outreach to confirm therapy start and assess early treatment experience.
Coordinate patient appointments, follow‑up visits, and clinical monitoring schedules.
Shields Health Solutions partners with hospitals and health systems to develop and manage specialty pharmacies. They focus on improving patient outcomes, enhancing financial performance, and ensuring regulatory compliance for their partners.
Be accountable for Partner satisfaction and relationship
Build trusting relationships with Partners’ operational leadership
Maintain a comprehensive understanding of business and technical challenges faced by customers
SmithRx is a rapidly growing, venture-backed Health-Tech company. Their mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector. They pride themselves for their mission-driven and collaborative culture that inspires their employees to do their best work.