Role Description As a Telepharmacist, you will deliver high-quality, patient-centered care across multiple hospitals using innovative technology. In this fully remote role, you will partner with clinical teams to ensure safe, effective medication management while enhancing care coordination and patient outcomes. Your clinical expertise and collaborative approach will support exceptional care delivery across diverse patient populations. - Provide remote pharmacy services, including order entry, verification, and clinical review to ensure safe and accurate medication use. - Collaborate with physicians, nurses, and interdisciplinary care teams to deliver timely clinical recommendations and improve patient outcomes. - Evaluate medication orders, identify potential interactions or risks, and recommend appropriate therapeutic adjustments. - Deliver drug information and clinical guidance related to dosing, administration, and disease management. - Support care across diverse patient populations, including pediatric, geriatric, and medically complex patients. - Document all clinical activity accurately and completely within pharmacy systems. - Maintain compliance with federal and state regulations, accreditation standards, and organizational policies. - Utilize multiple pharmacy information systems and technology tools to deliver efficient, high-quality care. - Participate in training, onboarding, and continuous learning to maintain knowledge across systems and client environments. - Support quality improvement initiatives and contribute to performance and productivity goals. - Escalate and assist in resolving medication-related concerns or variances in a timely manner. Qualifications - Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy. - Active Pharmacist license with ability to obtain and maintain licensure in multiple states. - Minimum of 2 years of hospital or inpatient pharmacy experience. - Strong clinical knowledge including medication therapy management, drug interactions, and disease state management. - Excellent communication skills with the ability to collaborate effectively across care teams. - Reliable high-speed internet connection suitable for remote work. - Licensed in a minimum of three of the following states: NY, WV, PA, OH, MA. Requirements - Experience in telepharmacy or supporting multiple hospital systems. - Familiarity with inpatient pharmacy operations, including IV admixtures, TPN, and specialty therapies. - Proficiency with pharmacy information systems and remote clinical technology platforms. - Strong organizational skills with the ability to manage multiple workflows in a fast-paced environment. - If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Benefits - Hourly rate of 54 - 91 USD / hourly, depending on relevant factors, including experience and geographic location. - Eligible to participate in an annual bonus plan. - Comprehensive range of health-related benefits including medical, vision, dental, and well-being and behavioral health programs. - 401(k) and company paid life insurance. - Tuition reimbursement. - A minimum of 18 days of paid time off per year and paid holidays. Company Description At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Role Description The Peer-to-Peer (P2P) Utilization Review Nurse is an integral member of the MGB Central Utilization Management team, specializing in identifying, preparing, and clinically reviewing cases requiring peer-to-peer engagement with payers. This role focuses on concurrent level-of-care denials and supports physician advisor–led peer-to-peer discussions through expert clinical analysis, application of nationally recognized criteria, and comprehensive documentation. The P2P Utilization Review Nurse functions with a high degree of autonomy and clinical judgment, managing a high volume of complex cases across multiple entities. Working in close collaboration with Physician Advisors, Emergency Department providers, admitting teams, Care Management, and non-clinical UM partners, this role ensures accurate level-of-care determinations, supports appeal and reconsideration pathways, and promotes consistent, compliant utilization practices. The P2P Utilization Review Nurse reports to Utilization Management leadership within the centralized UM structure. Primary Responsibilities: - Apply nationally recognized criteria (InterQual and/or MCG) and organizational guidelines to evaluate payer denials and determine appropriateness of inpatient versus observation status. - Perform detailed clinical record reviews to assess medical necessity, intensity of service, and severity of illness in preparation for peer-to-peer review and identify cases appropriate for peer-to-peer review versus downgrade or reconsideration (CONI), using established exclusionary criteria and the P2P Standard of Work. - Document clinical rationale, level-of-care determinations, and recommendations clearly and accurately in EPIC, utilization management notes, and designated tracking tools, and maintain and update required P2P tracking tools, including documenting review status, outcomes, and next steps in accordance with standardized workflows. - Collaborate closely with Physician Advisors to prepare cases for peer-to-peer discussions, including participation in scheduled prep meetings and real-time clinical clarification. - Serve as a subject matter expert for utilization management, payer denial trends, and peer-to-peer workflows for internal stakeholders and communicate effectively with Emergency Department providers, admitting providers, Care Managers, and UM colleagues to ensure alignment on patient class determinations and care progression. - Support reconsideration (CONI) processes through RN-to-RN collaboration with payers when new or additional clinical information becomes available, and escalate complex or unresolved cases to Physician Advisors when payer determinations conflict with clinical findings or established criteria. - Assist with departmental needs during periods of high demand, including additional reviews, appeal preparation, and workflow support, and participate in quality improvement initiatives, denial trend analysis, and identification of learning opportunities related to utilization management and peer-to-peer outcomes. - Complete special assignments and projects demonstrating expert-level knowledge of utilization review criteria and peer-to-peer processes. Qualifications - Required: Bachelor's of Science, Nursing (BSN) - RN license - 5+ years clinical nursing experience in an acute care hospital setting - 3+ years utilization review, care management or utilization management experience - 1+ years experience applying InterQual and/or MCG criteria for level of care determination - 1+ years experience reviewing and managing payer denials, ability to perform independent, complex clinical record reviews, and experience collaborating with physicians, physician advisors, and interdisciplinary teams to resolve level of care issues - Proficiency with electronic medical records (EPIC preferred) and utilization management documentation workflows - Preferred: Experience supporting or preparing cases for peer-to-peer (P2P) discussions with payers - Certification in Utilization Review (CPUR), Case Management (CCM), or related specialty - Experience with appeals, reconsideration (CONI) processes, or denial trend analysis Additional Knowledge, Skills and Abilities - Strong clinical background with the ability to synthesize complex medical information. - Expert-level knowledge of utilization review principles, level-of-care determination, and payer reimbursement guidelines. - Demonstrated proficiency with InterQual and/or MCG criteria. - Advanced critical thinking skills with confident, independent clinical decision-making. - Ability to influence, negotiate, and collaborate effectively with providers, physician advisors, and interdisciplinary teams. - Strong written and verbal communication skills, with emphasis on clear clinical documentation. - High level of organizational skills and ability to manage multiple complex cases simultaneously. - Comfort functions autonomously in a fast-paced, high-volume, centralized review environment. - Proficiency with EPIC and utilization management tracking tools. Additional Job Details - Schedule and Work Model: Remote / Work from Home. - 32 hours per week on a rotating schedule, within standard business hours. - On remote workdays, employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment. - Remote Type: Remote - Work Location: 399 Revolution Drive - Scheduled Weekly Hours: 32 - Employee Type: Regular - Work Shift: Day (United States of America) - Pay Range: $58,656.00 - $142,448.80/Annual - Grade: 98TEMP

• Provide remote pharmacy services, including order entry, verification, and clinical review to ensure safe and accurate medication use • Collaborate with physicians, nurses, and interdisciplinary care teams to deliver timely clinical recommendations and improve patient outcomes • Evaluate medication orders, identify potential interactions or risks, and recommend appropriate therapeutic adjustments • Deliver drug information and clinical guidance related to dosing, administration, and disease management • Support care across diverse patient populations, including pediatric, geriatric, and medically complex patients • Document all clinical activity accurately and completely within pharmacy systems • Maintain compliance with federal and state regulations, accreditation standards, and organizational policies • Utilize multiple pharmacy information systems and technology tools to deliver efficient, high-quality care • Participate in training, onboarding, and continuous learning to maintain knowledge across systems and client environments • Support quality improvement initiatives and contribute to performance and productivity goals • Escalate and assist in resolving medication-related concerns or variances in a timely manner

Role Description Provide professional assessment and review for the medical necessity of treatment requests and plans. - Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness. - Review inpatient hospital stay including mental health, substance abuse, skilled nursing, and rehabilitation for medical necessity. - Conduct post claim or post service reviews. - Cross train and provide cross coverage as needed. - Work to the top of the RN license and ensure proper referral to medical director for denial authorizations through independent review organizations (IRO). - Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care. - Refer requests that fall outside of established guidelines to advance review or senior care consultants. - Process appeals for non-certification of services and complete non-certification letters when appropriate. - Review plan document for benefit determinations and attempt to redirect providers and patients to PPO providers. - Identify and refer potential cases to case management, wellness, chronic disease, and Nurturing Together programs. - Complete documentation for all reviews in appropriate documentation software. - Utilize guidelines in appropriate hierarchy, including MCG guidelines, internal medical policies, group specific policies, and NCCN. - Meet productivity, quality, and turnaround times daily. - Pass external audits to include URAC and NCQA. - Maintain HIPAA compliance per company’s policy and procedures. - Maintain confidentiality and minimum requirement rules. - Complete all required yearly training per company’s expected time limit. - Complete and pass all annual testing including IRRA at 90% or higher. Qualifications - Current RN license in the United States or U.S. territory. - Associate’s degree or diploma (Nursing program) required. - 1+ year clinical experience required. Requirements - Ability to perform the essential job functions safely and successfully with or without reasonable accommodation. - Ability to maintain regular, punctual attendance. - Ability to sit for 6-8 hours. - Constant use of computer keyboard and mouse; repetitive use of both hands. - Occasional to frequent twisting of neck; occasional bending of neck and at waist. - Must be able to remain in a stationary position 50% of the time. - Occasionally move about inside the office to access office machinery, filing cabinets, and meeting facilities. - Constantly operate a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. - Frequently position self to maintain files in file cabinets. - Frequently move boxes or equipment weighing up to 25 pounds. - Must communicate information and ideas so others understand. - Must be able to observe details at close range. Benefits - Competitive base salary and benefits effective day one. - Comprehensive medical and dental through our own health solutions. - Paid Time Off—rest and recharge time is non-negotiable. - Mental health support, retirement planning, and financial protection. - Professional development with clear career progression and learning budgets. - Mission-driven culture where diverse perspectives drive real impact on people's health. Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Company Description Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive.