• Overall case guidance and consulting to ensure that fraud, waste, and abuse efforts are performed with the highest and most current clinical standards • Apply health plan review hierarchy to member contracts, medical policy, clinical guidelines and other approved resources to render timely decisions on services provided to members • Perform reviews and participate in peer-to-peer discussions of inpatient DRG Clinical Validation audits and appeals • Serves as a resource for information and consultation on the issues related to utilization management and clinical services • Approval and direction of consultant reviews. Participation in and support of overpayment recoveries • Support as needed to internal and external agencies in conjunction with these reviews such as but not limited to the Special Investigations Unit • Review of services suspected of being performed for purposes not medically necessary. Appropriate documentation of decisions and follow-up • Comply with all state, federal, and regulatory requirements • Other duties as necessary to ensure progression and completion of reviews • Participate on projects and committees as necessary

Our Company PharMerica Overview The Clinical Pharmacy Lead is responsible for developing and maintaining client-facing clinical products and programs that distinguish the Company’s level of excellence for optimizing resident care, to drive internal education initiatives that advance the knowledge base and clinical proficiency of the Company’s healthcare provider teams, and for growing the Company’s status as a Thought Leader through collaboration with Marketing initiatives. The Clinical Pharmacy Lead provides clinical insight to support the Client Reporting and Formulary Management efforts of the department and works with Purchasing and Trade to support strategic partnerships. The Clinical Pharmacy Lead is responsible for identifying and responding to internal and external clinical needs and creating solutions to meet client requests. Remote: Can reside anywhere within the Continental USA. Schedule: Monday - Friday, 8am to 5pm Required: Must have earned PharmD degree Geriatric Pharmacy Specialty Certification (BCGP), preferred Three (3) or more years of experience in clinical pharmacy, clinical programs, or a related role. Strong understanding of geriatric pharmacotherapy and long term care clinical guidelines Benefits and perks for You!    • Medical, Dental, Vision insurance    • Health Savings & Flexible Spending Accounts (up to $5,000 for childcare)    • Tuition discounts & reimbursement    • 401(k) • Company Paid Time Off* • Shift Differential • DailyPay • Pet Insurance • Employee wellness and discount programs Responsibilities - Leads the design, implementation, execution, and ongoing management of clinical programs (e.g., Stewardship Programs, Fall Risk Toolkit, Vaccine Initiatives, etc.) - Maintains the Company’s clinical resource library (e.g., Client Alerts, In-Services, Factsheets, etc.) to bolster the Company’s Illuminate Education and Thought Leadership - Serves as internal contact to provide consultative clinical input to other Company business units - Tracks and understands regulatory trends and developing resources that assist clients and operations in maintaining compliance - Responsible for furthering the Company’s standing as an industry thought leader, through maintenance of a Speaker’s Bureau, facilitating engagement at select industry meetings and speaker opportunities - Provides clinical expertise in business reviews to demonstrate program effectiveness, outcomes, and return on investment - Assisting in the tracking, implementation, and communication of updates to PharMerica’s Standard Formularies - Analyzes clinical, utilization, and financial data to identify trends, patterns, and actionable opportunities for clinical improvement and cost containment - Partners with Account Management and Sales teams to support client reviews, value demonstrations, and consultative discussions - Participates in cross‑functional projects and additional initiatives as needed to support evolving organizational priorities - Maintaining business relationships with internal and external partners - Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards Qualifications - PharmD degree - BCGP preferred - Three (3) or more years of experience in clinical pharmacy, clinical programs, or a related role. - Strong understanding of geriatric pharmacotherapy and long term care clinical guidelines - Demonstrated ability to design and execute targeted clinical programs - Advanced analytical, organizational, and presentation skills - Ability to communicate complex data clearly to both clinical and non clinical audiences - Proficiency in Microsoft Excel or pharmacy analytics tools - Behavioral Competencies - Analytical thinking and problem solving - Strategic planning and execution - Strong written and verbal communication skills - Customer focused and results oriented mindset About our Line of Business PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.

Job Summary: The Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population with culturally competent delivery of care, services and supports. Facilitates communication, coordinates care and service of the member through assessments, identification, person-centered planning, assist the member in creation and evaluation of person-centered care plans to prioritize and address what matters most, behavioral, physical and social determinants of health needs with the aim to improve the of lives our members. Essential Functions: - Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks - Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member - Engage with the member to establish an effective, professional relationship via telephonic or electronic communication - Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member’s desires, needs and preferences - Identify and manage barriers to achievement of care plan goals - Identify and implement effective interventions based on clinical standards and best practices - Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management - Facilitate coordination, communication and collaboration with the member the ICT in order to achieve goals and maximize positive member outcomes - Educate the member/ natural supports about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made - Employ ongoing assessment and documentation to evaluate the member’s response to and progress on the ICP - Evaluate member satisfaction through open communication and monitoring of concerns or issues - Monitors and promotes effective utilization of healthcare resources through clinical variance and benefits management - Verify eligibility, previous enrollment history, demographics and current health status of each member - Completes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders - Oversee (point of contact) timely psychosocial and behavioral assessments and the care planning and execution of meeting member needs - Participate in meetings with providers to inform them of Care Management services and benefits available to members - Assists with ICDS model of care orientation and training of both facility and community providers - Identify and address gaps in care and access - Collaborate with facility-based healthcare professionals and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner - Coordinate with community-based organizations, state agencies, and other service providers to ensure coordination and avoid duplication of services - Adjust the intensity of programmatic interventions provided to member based on established guidelines and in accordance with the member’s preferences, changes in special healthcare needs, and care plan progress - Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required on going care coordination. - Provide clinical oversight and direction to unlicensed team members as appropriate - Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation - Continuously assess for areas to improve the process to make the members’ experience with CareSource easier and shares with leadership to make it a standard, repeatable process - Adherence to NCQA and CMSA standards - Perform any other job duties as requested Education and Experience: - Nursing degree from an accredited nursing program or Bachelor’s degree in a health care field or equivalent years of relevant work experience is required - Advanced degree associated with clinical licensure is preferred - A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required - Three (3) years Medicaid and/or Medicare managed care experience is preferred Competencies, Knowledge and Skills: - Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence - Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel - Ability to communicate effectively with a diverse group of individuals - Ability to multi-task and work independently within a team environment - Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices - Adhere to code of ethics that aligns with professional practice - Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice - Strong advocate for members at all levels of care - Strong understanding and sensitivity of all cultures and demographic diversity - Ability to interpret and implement current research findings - Awareness of community & state support resources - Critical listening and thinking skills - Decision making and problem-solving skills - Strong organizational and time management skills Licensure and Certification: - Current unrestricted clinical license in state of practice as a Registered Nurse, Social Worker or Professional Clinical Counselor is required. Licensure may be required in multiple states as applicable based on State requirement of the work assigned - Case Management Certification is highly preferred Working Conditions: - Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer - Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members Compensation Range: $62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1

• Market Physician Executive (MPE) are mission driven physician leaders who are dedicated to improving the well-being, quality of life, and health outcomes for our patients • The MPE will lead our in-home multi-specialty polychronic care model in an assigned market • Collaborate with Monogram Health’s Multi-Specialty Platform to leverage employed specialists to deliver in-home specialty care • Reporting to the Region President, the Market Physician Executive (MPE) oversees the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market • Provide clinical guidance and direction to Market teams to drive Population Health Management activities • Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways • Conduct patient reviews to target high utilizers, high risk and high opportunity patients and patient cohorts