Stellus Rx

• Develop comprehensive strategies to optimize relationships with payors, including negotiating contracts, rates, and terms. • Monitor industry trends, regulatory changes, and competitor activities to inform payor negotiation strategies. • Collaborate with senior leadership to align payor strategies with organizational goals and objectives. • Lead negotiations with payors to secure favorable contract terms, reimbursement rates, and payment methodologies. • Evaluate proposed contracts and amendments to ensure alignment with organizational priorities and financial targets. • Manage contract compliance, including monitoring performance metrics, resolving disputes, and implementing corrective actions when necessary. • Oversee the credentialing and enrollment process for healthcare providers, ensuring timely and accurate submissions to payors. • Maintain up-to-date knowledge of credentialing requirements, regulations, and accreditation standards. • Coordinate with internal departments (e.g., provider relations, revenue cycle) to streamline credentialing workflows and minimize delays. • Collaborate with revenue cycle management teams to identify opportunities for improving billing processes, claims submission, and reimbursement efficiency. • Analyze revenue cycle data and performance metrics to identify trends, root causes of denials, and opportunities for revenue enhancement. • Implement best practices and process improvements to optimize revenue cycle performance and reduce revenue leakage. • Cultivate and maintain strong relationships with key stakeholders at payor organizations, including executives, contracting representatives, and network managers. • Serve as the primary point of contact for payors regarding contract negotiations, issue resolution, and strategic initiatives. • Advocate for the organization's interests while fostering collaborative partnerships with payors to achieve mutual goals.

• Develop, construct, and maintain large-scale data processing systems that collect data from a variety of structured and unstructured sources. • Build and optimize ELT pipelines using AI-assisted tooling to identify bottlenecks, suggest optimizations, and automate routine pipeline maintenance tasks. • Identify, design, and implement internal process improvements: use AI to automate manual processes, optimize data delivery, and re-design infrastructure for greater scalability. • Build the infrastructure required for optimal extraction, transformation, and loading of data from various sources. • Prepare data for data scientist exploration and discovery using AI-assisted data profiling and quality assessment tools. • Perform data wrangling and munging for downstream analytics and machine learning. • Enable large-scale machine learning by designing and maintaining annotated datasets, elastic search approaches, and scalable data lake structures that support AI/ML workloads. • Create and maintain analytics pipelines that generate data and insight to power business decision-making. • Collaborate with data scientists, analysts, and business stakeholders on requirements for dimensional modeling and ETL pipelines. • Develop and maintain data quality frameworks; use AI to automate anomaly detection, schema validation, and data contract enforcement across pipelines.

• Use AI tools to generate, review, and optimize automated test cases. • Leverage AI-assisted analysis to understand code flow and component interactions. • Build and maintain automation test suites across Mobile, Desktop, and Web platforms. • Apply AI tools to identify gaps in existing test coverage and prioritize high-risk areas. • Investigate user problems using AI-powered analysis and create bug reports. • Integrate automated test suites into CI/CD pipelines and monitor test results. • Develop and maintain status reporting and dashboards on testing activities. • Participate in backlog refinement and design test cases. • Collaborate with deployment teams to resolve issues and improve testability. • Research test tools, methodologies, and AI-driven QA trends.

• Assists team members by providing support, identifying adherence barriers, improving adherence, and facilitating team success and growth. • Leads the Adhere Technician team to provide support, identifying adherence barriers, improving adherence, and accurately facilitating patient compliance. • Understands and maintains confidentiality with respect to patient/client care; complies with all federal and state laws applicable to confidentiality of protected health information (PHI) and electronic protected health information (ePHI); follows HIPAA guidelines. • Adheres to and helps communicate all departmental and company policies to team members as needed. • Leads and supports daily technician operations. • Mentors, trains, and supports fellow team members to ensure strong performance and continuous development. • Manages direct reports, facilitating their professional growth, providing ongoing coaching, and supporting career development. • Conducts formal 1:1 meetings with direct reports to review performance, set goals, and document progress. • Oversees and approves direct reports’ timecards, ensuring accuracy, compliance, and timely submission. • Collaborates cross‑functionally to improve workflows and drive operational efficiency. • Serves as a point of contact for escalations and quality assurance. • Reviews patient profiles to identify potential medication-related issues and discrepancies. • Collects and analyzes medication-related data to identify trends and opportunities for improvement. • Generates and analyzes reports on medication adherence, patient outcomes, and other relevant team metrics. • Assists the Adhere Quality Team with onboarding, training, and other quality-related tasks as needed. • Promotes teamwork, professional services, and clear communication. • Performs other related duties as assigned.

• Use AI coding tools as a primary part of your development workflow. • Ensure accuracy of architecture through analysis and thorough problem resolution. • Build web and mobile applications with a mindset of leveraging AI. • Work in a DevOps environment with understanding of CI/CD pipelines. • Interface with NoSQL and relational databases; design and optimize data access patterns. • Communicate effectively with scrum teams and Product Owners. • Develop and maintain web service integrations across a modern AWS cloud stack.

• Designing, implementing, and overseeing pharmaceutical programs within a population health management framework. • Collaborating with healthcare teams, analyzing population health data, and developing strategies to optimize medication usage. • Creating educational materials and initiatives to enhance patient understanding of medication usage. • Ensuring compliance with regulatory standards related to pharmaceutical services. • Providing leadership to the pharmacy team and establishing key performance indicators (KPIs).

• Leverage AI-powered security tooling to continuously monitor for threats, anomalies, and policy violations across cloud and application environments • Respond to and resolve or escalate security incidents; use AI-assisted analysis to accelerate root cause investigation and postmortem documentation • Investigate and resolve security violations by providing postmortem analysis that illuminates causes, solutions, and AI-informed preventative measures • Use AI tools to model attack scenarios and prioritize remediation efforts based on risk • Assess, design, implement, automate, and document security solutions for public and private cloud environments • Implement "security as code" using cloud services and CI/CD components • Develop baseline cloud, container, and application security standards and integrate them into CI/CD pipelines • Work with diverse technical and business stakeholders on security best practices • Document security systems, procedures, and controls; drive compliance through adherence to information security policies

• Serve as a key liaison between Product Management, Engineering, Operations, and end users • Translate business needs into clear requirements and actionable insights • Maintain ownership of requirement documentation throughout the product lifecycle • Ensure the quality and usability of product deliverables • Contribute to continuous improvement initiatives by identifying process inefficiencies • Leverage AI tools to improve speed, quality, and decision-making across the PDLC and SDLC • Actively champion and model AI-enabled ways of working within the Product, Engineering, and Operations teams • Gather, analyze, and prioritize business and user requirements • Collaborate closely with Product Owner to define product scope • Support engineering teams by using AI to clarify requirements • Analyze product performance, user behavior, and operational data

• Define and maintain all aspects of the solution, technical, integration, and data architecture for applications • Define and maintain standards and patterns, developer tools, technology upgrades, and mentor and guide developers • Coordinate technical tasks with technical owner and project owner • Collaborate with other professionals to determine functional and non-functional requirements for new software or applications • Identify and communicate risks to the business • Research new technologies, maintain roadmap of adopted technologies • Develop high-level product specifications with attention to system integration and feasibility • Ensure the delivered solution meets the technical specifications and design requirements • Oversee progress of development team to ensure consistency with initial design

Role and Responsibilities The Clinical Pharmacist will help our communities thrive by optimizing medication management to allow our physicians more time to focus on patient care and support care coordination for assigned patient cohorts. The Clinical Pharmacist will work closely with the care coordination team and with physicians to ensure assigned patients are on intended prescribed therapies, understand their medication therapy and receive appropriate adherence coaching. Core Functions - The Clinical Pharmacist reports to the management staff. Daily tasks will also be directed by the pharmacy services team. - Provides telephonic follow up with members to provide medication reconciliation and medication management to assigned patients including transitional care and chronic disease support. - Complete assigned tasks related to medication management services. - Working with member, physician, health system(s), pharmacy services, and other care providers to meet the member’s individual needs based on protocols and referrals, - Coordinating transitional management including: - Obtaining medication orders - Complete medication reconciliation. - Work with Engage team to ensure medication provided until PCP follow-up. - The Clinical Pharmacist, Engage: - Provides medication management services utilizing prescribed workflows. - Complete assigned appointments in accordance with workflow. - Assess patient adherence behaviors. - Eliminate barriers to adherence. - Assess appropriateness of therapy provided by the pharmacy. - Document appropriately in Engage application and EnterpriseRx as applicable. - Work with central or local pharmacy to obtain and process prescriptions. - Communicate with providers regarding services provided. - Support the member education goals regarding their specific chronic condition based on the Plan of Care. - Support the evolution of pharmacy services delivery for key patient populations if applicable. - All communications will be conducted in a professional manner. - Remains objective and unbiased decisions in their medication management review and recommendations and not participate in any way in the delivery of care to the patient. - Administers tasks as detailed in the member specific Plan of Care. - Completes clear and concise documentation in Care Management programs. - Complies with Customer Service expectations as applicable to the Department and Health Plan. - Comply with all departmental policies and procedures. - Participate in departmental and company in-services as appropriate. - Recognizes and adheres to the scope / limitations of job requirements. - Performs other related duties as assigned. Qualifications and Education Requirements - PharmD - TX state pharmacy license and/or assigned market license. - Strong patient engagement skills including active listening, de-escalation intervention training and ability to teach complex topics in an understandable manner. - Strong organizational and time management skills, able to work with little supervision while handling numerous projects at once. - Excellent written/verbal communication skills, especially the ability to communicate telephonically in a professional and effective manner. - Computer literacy in Word, Excel. Location Plano, Texas (Remote) Department 5500 - Rx Engage Employment Type Full Time