Current jobs related to Pharmacy Benefits Consultant - Springfield - PacificSource

  • Pharmacy Benefits Strategist

    1 month ago

    Springfield, United States PacificSource Health Plans Full time

    Job SummaryWe are seeking a highly skilled Pharmacy Benefits Strategist to join our team at PacificSource Health Plans. As a key member of our pharmacy team, you will be responsible for supporting all aspects of the pharmacy benefit and reporting, while working closely with Pharmacy leadership to design, implement, and coordinate pharmacy program...

  • Pharmacy Benefits Strategist

    4 weeks ago

    Springfield, United States PacificSource Full time

    Job Title: Pharmacy Benefits StrategistAt PacificSource, we are seeking a highly skilled Pharmacy Benefits Strategist to join our team. As a key member of our pharmacy team, you will play a critical role in designing, implementing, and coordinating pharmacy program initiatives.Key Responsibilities:Provide oversight and quality assurance to ensure accurate...

  • Pharmacy Benefits Strategist

    4 weeks ago

    Springfield, United States PacificSource Health Plans Full time

    ***Candidates must be located near one of the following PacificSource locations:Portland, OregonSpringfield, OregonBend, OregonSalem, OregonBoise, IdahoSupport all aspects of the pharmacy benefit and reporting while working with Pharmacy leadership on designing, implementing, and coordinating pharmacy program initiatives. Support the pharmacy benefit and...

  • Pharmacy Benefits Strategist

    1 month ago

    Springfield, United States PacificSource Health Plans Full time

    ***Candidates must be located near one of the following PacificSource locations:Portland, OregonSpringfield, OregonBend, OregonSalem, OregonBoise, IdahoSupport all aspects of the pharmacy benefit and reporting while working with Pharmacy leadership on designing, implementing, and coordinating pharmacy program initiatives. Support the pharmacy benefit and...

  • Pharmacy Technician

    1 month ago

    Springfield, United States Maxor National Pharmacy Services, LLC Full time

    Pharmacy Technician PRN - APO Pharmacy Maxor National Pharmacy Services is currently accepting applications for a Per Diem Pharmacy Technician to work at APO Pharmacy, an in-house, clinic based specialty pharmacy.About MaxorMaxor is a leading pharmacy care solutions company dedicated to improving patient outcomes and lowering the total cost of care through...

  • Pharmacy Technician

    4 weeks ago

    Springfield, Illinois, United States Maxor National Pharmacy Services, LLC Full time

    About Maxor National Pharmacy Services, LLCMaxor National Pharmacy Services, LLC is a leading pharmacy care solutions company dedicated to improving patient outcomes and lowering the total cost of care through our clinically integrated set of pharmacy care services.About APO PharmacyAPO Pharmacy is a private not-for-profit organization providing health...

  • Sales Representative

    2 weeks ago

    Springfield, Illinois, United States Apotheco Pharmacy Full time

    Job SummaryThe Account Manager will serve as a key representative of Apotheco Pharmacies, fostering a positive customer experience and driving utilization growth. This role will be responsible for building and maintaining strong relationships with customers in the designated Fairfax, VA territory.Key ResponsibilitiesDevelop and execute territory plans to...

  • Pharmacy Technician II

    4 months ago

    Springfield, United States PacificSource Full time

    Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status,...

  • Pharmacist - Pharmacy Professional

    2 weeks ago

    Springfield, Virginia, United States Giant Food Full time

    About UsAhold Delhaize is a leading international retail company with a strong presence in Europe and North America. We take pride in our high-quality products and services, and we're committed to creating a positive impact on our customers, employees, and the communities we serve.Job SummaryWe're seeking a skilled Pharmacist to join our team at Giant Food....

  • Pharmacy Assistant

    3 weeks ago

    West Springfield, Massachusetts, United States Integritus Healthcar Full time

    Job SummaryWe are seeking a highly skilled Pharmacy Technician to join our team at Integritus Healthcar. As a Pharmacy Technician, you will play a vital role in ensuring the safe and effective preparation of medications for our patients.Key ResponsibilitiesPrepare medications pursuant to valid prescriptions, adhering to state and federal regulatory...

  • Pharmacy Technician

    2 weeks ago

    Springfield, Illinois, United States Sam's Club Full time

    Job SummaryAs a Pharmacy Technician at Sam's Club, you will play a vital role in providing exceptional service to our members by assisting with pharmacy operations, processing prescriptions, and maintaining a clean and organized pharmacy area.Key ResponsibilitiesProcess prescriptions and assist with pharmacy operationsProvide excellent customer service to...

  • Retail Pharmacy Manager

    6 days ago

    Springfield, Illinois, United States Cardinal Health Full time

    Job Summary:Cardinal Health is seeking a highly motivated and experienced Retail Pharmacy Manager to lead our Entity Owned Retail Pharmacy located within a health center. As a key member of our team, you will be responsible for managing the pharmacy operations, ensuring compliance with regulatory requirements, and providing exceptional patient...

  • Pharmacy Technician

    2 weeks ago

    Springfield, Ohio, United States Sam's Club Full time

    Job SummaryWe are seeking a highly skilled Pharmacy Technician to join our team at Sam's Club. As a Pharmacy Technician, you will play a critical role in ensuring the smooth operation of our pharmacy department, providing exceptional customer service, and supporting our pharmacists in delivering high-quality patient care.Key ResponsibilitiesProcess...

  • Hospital Pharmacy Intern

    2 days ago

    Springfield, United States Mercy Health Full time

    Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our...

  • Pharmacy Technician

    2 weeks ago

    Springfield, Ohio, United States Sam's Club Full time

    Job SummaryWe are seeking a highly skilled Pharmacy Technician to join our team at Sam's Club. As a Pharmacy Technician, you will play a critical role in ensuring the smooth operation of our pharmacy services, providing exceptional customer service, and supporting the pharmacy team in meeting our high standards of quality and safety.Key...

  • Pharmacy Technician

    2 weeks ago

    Springfield, Ohio, United States Sam's Club Full time

    Job SummaryWe are seeking a highly skilled Pharmacy Technician to join our team at Sam's Club. As a Pharmacy Technician, you will play a critical role in ensuring the smooth operation of our pharmacy department, providing exceptional customer service, and supporting our pharmacists in delivering high-quality patient care.Key ResponsibilitiesProcess...

  • Pharmacy Technician

    3 weeks ago

    Springfield, Illinois, United States Maxor Full time

    About MaxorMaxor is a leading pharmacy care solutions company dedicated to improving patient outcomes and lowering the total cost of care through our clinically integrated set of pharmacy care services.We put people first and are committed to providing outstanding service across all aspects of our business.Job SummaryWe are seeking a highly skilled Pharmacy...

  • Pharmacy Technician

    3 weeks ago

    Springfield, Massachusetts, United States UnitedHealth Group Full time

    Pharmacy Technician Job DescriptionWe are seeking a skilled Pharmacy Technician to join our team at UnitedHealth Group. As a Pharmacy Technician, you will play a vital role in supporting the pharmacy functions and ensuring the smooth operation of our clinics.Key Responsibilities:Fills prescription orders and makes them available for verification under the...

  • Pharmacy Technician

    2 weeks ago

    Springfield, Ohio, United States Walgreens Full time

    Job Description:As a Pharmacy Technician at Walgreens, you will play a vital role in providing exceptional patient care and service. Our pharmacy technicians are the face of our pharmacy, interacting with customers and developing strong relationships with patients.We are committed to investing in our pharmacy technicians, providing them with the tools and...

  • Pharmacy Tech

    4 weeks ago

    Springfield, United States CoxHealth Full time

    Summary CoxHealth, a leading Magnet designated healthcare system serving 25 counties in Missouri.If you would like to know a bit more about this opportunity, or are considering applying, then please read the following job information.CoxHealth is consistently nominated as a best place to work.For 2023, CoxHealth has received the following recognitions: Best...

Pharmacy Benefits Consultant

2 months ago

Springfield, United States PacificSource Full time

***Candidates must be located in the general Springfield/Eugene area***

In this role, you will be instrumental in overseeing all facets of pharmacy benefits and reporting, collaborating closely with Pharmacy leadership to design, implement, and coordinate innovative pharmacy program initiatives. Your focus will encompass Pharmacy Benefit Management (PBM) operations, utilization management platform operations, pharmacy data analytics, and business analysis aimed at process enhancement.

Key Responsibilities:

  • Ensure quality assurance and oversight for the accurate establishment of pharmacy benefit designs, formulary coding, network coding reporting, and drug pricing through meticulous PBM configuration testing and claims analysis.
  • Work in tandem with Sales, Product Development, and Pharmacy teams to guarantee precise and effective pharmacy benefit designs and initiatives.
  • Assist the Sales team by generating and analyzing claims data, formulary comparisons, and projections for both new and existing groups.
  • Manage the interface between vendors, consultants, and clients to facilitate efficient coordination and implementation of coding, ensuring appropriate oversight and monitoring of all PBM operations, data interfaces, and external communications.
  • Support formulary administrators and leadership on initiatives, tasks, and projects related to all aspects of the pharmacy benefit across various lines of business (Medicare, Medicaid, Commercial).
  • Conduct ongoing drug and claim configuration setup and testing to ensure the accuracy of point-of-service adjudication.
  • Provide claims research, analysis, and support during both internal and external audits.
  • Investigate, troubleshoot, and resolve claims issues, while documenting service warranties.
  • Generate and analyze reports for new and transitioning groups.
  • Develop and maintain Pharmacy department policies and procedures to reflect new best practices and guidance.
  • Organize, document, and support departmental performance dashboards.
  • Track and record drugs at launch to assist clinicians in making coverage and formulary decisions.
  • Facilitate ongoing communication efforts, including notifications to members, pharmacies, and providers.
  • Create reports using internal reporting software and perform thorough data extraction from our data warehouse to meet pharmacy reporting, analysis, and projection demands.
  • Analyze medical and pharmacy claims to identify cost-saving opportunities and process improvements, promoting cross-departmental prioritization of pharmacy initiatives.
  • Present complex data, analyses, and findings to internal and external teams in a clear and comprehensible manner.
  • Engage in special projects and committees as needed.

Supporting Responsibilities:

  • Meet departmental and company performance and attendance expectations.
  • Adhere to privacy policies and HIPAA regulations concerning the confidentiality and security of protected health information.
  • Perform additional duties as assigned.

Success Profile:

Work Experience: A minimum of five years of experience in a healthcare setting is required, with a preference for experience in managed care or pharmacy. Experience with Medicare Star ratings, Medicaid quality initiatives, and NCQA standards is also preferred.

Education, Certificates, Licenses: A bachelor's degree is required, preferably in public health, healthcare-related fields, mathematics, statistics, data science, or a similar research-related discipline. Equivalent years of relevant experience may be considered in lieu of a degree. Strong preference for certification in data software such as RxClaim, SQL, SAS, Excel, or Tableau.

Knowledge: Proficient computer skills are essential, particularly within Microsoft applications like Word and Excel. Excellent verbal and written communication skills are required, along with a solid understanding of medical terminology. The ability to define and prioritize problems and manage workload independently is crucial, as is the capacity to work under tight deadlines. Familiarity with RxClaim PBM software and claims analysis is necessary, with SQL experience preferred.

Competencies:

Adaptability, Building Customer Loyalty, Building Strategic Work Relationships, Building Trust, Continuous Improvement, Contributing to Team Success, Planning and Organizing, Work Standards.

Environment: This position is primarily office-based with ergonomically configured equipment. Occasional travel may be required.

Skills: Accountability, Communication (written/verbal), Flexibility, Active Listening, Organizational Skills, Problem Solving, Teamwork.

Our Values: We are dedicated to upholding our core values, which guide our business practices and foster a culture of integrity, teamwork, customer service, open communication, community engagement, social justice, equity, diversity, and innovation.

Physical Requirements: The role requires the ability to stoop, bend, sit, and/or stand for extended periods while performing core job functions. Repetitive motions such as typing, sorting, and filing are involved, along with light lifting and carrying of files and business materials. Proficiency in reading and comprehending both written and spoken English is essential, as is the ability to communicate clearly and effectively.

Disclaimer: This job description outlines the general nature and level of work performed by employees in this position and is subject to change. It is not intended to be a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this role. Employment remains at-will at all times.

Diversity and Inclusion: We value the diversity of our workforce and are committed to fostering an inclusive environment where individual differences are appreciated and respected, enabling us to fully develop and utilize each person's talents and strengths.