• Identify patients at risk for medication nonadherence using payer reports, EHR worklists, and pharmacy dispensing data • Conduct outbound patient outreach to improve adherence and address barriers to therapy • Coordinate medication refill reminders, synchronization, and home delivery services • Assist patients with prior authorizations, financial assistance programs, manufacturer copay cards, and insurance navigation • Escalate clinical concerns to pharmacists or providers when medication-related issues are identified • Support transitions of care by ensuring patients obtain discharge medications and understand their medication regimen • Document all patient interactions and interventions in the electronic health record • Monitor performance for Medicare Star Ratings, HEDIS, medication adherence, and other quality measures • Review payer and provider reports to identify opportunities for intervention and gap closure • Collaborate with pharmacists, providers, care managers, and population health teams to coordinate patient care • Track intervention outcomes and assist with reporting on key performance indicators • Participate in outreach campaigns for preventive care and chronic disease management initiatives • Assist with medication reconciliation and ensure accurate medication lists across care settings • Maintain accurate documentation and comply with regulatory, payer, and organizational requirements

Role Description Molina Healthcare is hiring for a Pharmacist, Quality Withhold in our Clinical/Medication Therapy Management department. This position is remote but will work Eastern Standard Hours. This role will be reviewing quality measures for Massachusetts. Highly qualified candidates will have a background in Managed Care, Adherence, Medicaid, and/or Quality Withhold. - Provides support and subject matter expertise for pharmacy Medication Therapy Management (MTM) and clinical pharmacy services activities. - Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. - Facilitates Medication Therapy Management (MTM) support including examination of member medical records, comprehensive medication reviews, and communication with members and providers (includes outbound calls to members to discuss medications). - Reviews member medication profiles and applies evidence-based medicine and national guidelines when creating recommendations for health care providers for optimization of member medication regimens. - Analyzes and reviews medication lists for potential patient safety issues, including drug interactions, suboptimal medication regimens, etc. - Promotes clinically appropriate prescribing practices based on evidence-based medicine and national guidelines through various modalities (provider/plan profiling, member drug profile reviews, medication protocols/criteria, and case-by-case interventions). - Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed. - Performs prior authorization reviews of high-cost medications and deferred authorization requests as needed. - Researches, develops, and implements drug utilization and disease state management strategies and intervention techniques to deliver high quality, cost effective health care. - Assists in coordination of care for pharmacy-related issues between members, providers and other members of the member's interdisciplinary care team (ICT), including referrals to state plan healthcare services. - Follows-up with members and providers to check on progress toward meeting drug treatment goals. - Serves as a drug information resource to pharmacy staff, medical affairs staff, and providers. - Reviews and analyzes Pharmacy Benefit Manager (PBM) reports to track general trends in drug utilization and identify potential targeted utilization management activities. - Works with healthcare services team (e.g., data managers, care managers, etc.) on member-centered interdisciplinary teams. - May prepare drug monographs and utilization reports for the Pharmacy and Therapeutics (P&T) committee. - Assists leadership in developing/updating policies and procedures, and implementing changes to comply with state and federal regulations. Qualifications - At least 3 years of experience in a pharmacy, Medication Therapy Management (MTM), Pharmacy Benefit Manager (PBM), and/or managed care setting, or equivalent combination of relevant education and experience. - Doctor of Pharmacy (PharmD). License must be active and unrestricted in applicable state(s) of practice. - Demonstrated knowledge and expertise in clinical pharmacology and disease management. - Clinical skills related to Medication Therapy Management (MTM). - Demonstrated knowledge of best practices in Medication Therapy Management Program (MTMP) related disease states. - Current knowledge and expertise in clinical pharmacology and disease management. - Ability to present ideas and information concisely to varied audiences. - Knowledge of processes and systems, and ability to develop and deliver necessary training to departmental staff and internal customers. - Ability to develop and maintain positive and effective work relationships with coworkers, members, providers, regulatory agencies and vendors. - Proficiency in compiling data, creating reports and presenting information. - Ability to meet established deadlines. - Functions independently and manages multiple projects. - Excellent verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. Preferred Qualifications - Board Certified Ambulatory Care Pharmacist (BCACP). - American Pharmacist's Association Medication Therapy Management (MTM) certificate. - Medicaid and/or Medicare experience. - Clinical skills or pharmacotherapy expertise for Medication Therapy Management Programs (MTMP) related conditions and medications. - Experience with team-based care. Benefits Molina Healthcare offers competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description As the Alliance Leader, you will own the partner management function for Boston Consulting Group (BCG). This includes: - Strategic partnership planning - Sponsor development - Capability development - Solution development - Thought leadership - Partnership promotion - Business development - Relationship management You will report to the VP, Partner Program. The impact you will have: - Expand the mindshare for Databricks within the BCG partner organization by nurturing and developing multiple sponsors and stakeholders. - Build a healthy and sustainable services business by: - Expanding skills and assets - Encouraging thought leadership - Supporting the development of relevant offerings - Promoting the relationship - Building a network of stakeholders - Identifying and advancing the pipeline - Demonstrate the impact of your partner on Databricks adoption via executive influence and thought leadership. Qualifications - Leadership: experience working with senior executives - Management Consulting: 10+ years of experience with management consulting providers - Relationship Management & Planning: balancing priorities within a relationship to optimize outcomes - Working as a Team: ability to work across teams to drive outcomes, including account teams, sales management, solution architects, enablement leaders, cloud specialists, field marketing, and operations - Execution Readiness: support practice and skills development for C&SI Partners with a balanced approach to enablement programs, differentiated asset & offering development, internal promotion, marketing activities, and delivery excellence - Good Governance: work with your partner to ensure the right governance is in place, including agreements, executive relationships, and processes Requirements Pay Range Transparency: - Zone 1 Pay Range: $204,200 — $280,775 USD - Zone 2 Pay Range: $204,200 — $280,850 USD - Zone 3 Pay Range: $204,200 — $280,850 USD - Zone 4 Pay Range: $204,200 — $280,850 USD Benefits - Comprehensive benefits and perks that meet the needs of all employees - Specific details on the benefits offered in your region available upon request

Role Description Our PBM goal is to help clients better manage pharmacy spend to make drugs more affordable for their employees and dependents. Rightway is responsible for designing, building, and operating a new-to-the-world PBM model based on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers. The Specialty Pharmacy Technician / Specialty Pharmacy Guide (CPhT) is a member of the Rightway PBM Clinical Operations team. This role will be key in supporting our Specialty Clinical Pharmacists to deliver on the “pharmacist in the family” approach to engaging our members. We are looking for an experienced certified pharmacy technician to engage with our specialty members in a caring and empathetic manner. Written and verbal communication skills will be critical when interacting with members on the phone, via email, and via the chat function on the Rightway app. A willingness to go the extra mile to provide outstanding customer service is an essential requirement of this role. What You’ll Do - Serves as direct member and provider contact for specialty pharmacy benefit information, prior authorization requests, and navigation support. - Prior to the receipt of medication, provides support to members enrolled in specialty management programs, including: - Coordinating any needed prior authorization with the UM team - The fulfillment of the prescription with the specialty pharmacy partner - Enrollment in patient assistance programs - Billing questions - After receipt of medication, follow up with members to ensure satisfaction, connect member with a pharmacist for any clinical questions, and coordinate future refills. - Fields questions from members, human resources departments, pharmacies, and providers related to: - Specialty distribution - Benefit design - Formulary coverage and cost of medication - Prior authorization criteria - Claims adjudication - Copay/patient assistance - Supports Specialty Clinical Pharmacists in patient and provider outreaches, including: - Scheduling of appointments between members and pharmacists - Enrollment of members into copay or patient assistance programs - Medication adherence support - Other administrative tasks - Assists in ensuring all operating and productivity standards are met, which may include conducting quality reviews of calls, chats, and documentation notes to identify opportunities for improvement. - Ensures regulatory and privacy standards are consistently met. - Provide support to other teams within Clinical Operations, such as utilization management and navigation. Qualifications - Associate’s or Bachelor’s degree preferred. - 1-2 years experience in a pharmacy technician role within a Specialty pharmacy, PBM, pharmacy department of a health plan, or similar managed care setting. - Active Certified Pharmacy Technician (CPhT). - Detail-oriented, adaptable, critical thinker, empathetic. - Ability to dig deep in understanding an issue to get to true root cause and resolution. - Desire to improve a patient’s healthcare experience and provide concierge level service. - Knowledge of pharmacy claims adjudication and benefit designs/terminology. - Ability to multi-task and prioritize work. - Ability to work independently. Extra Credit - Bi-lingual preferred (Spanish). Compensation $22.00 - $23.00/hr. Compensation offered will be determined by geographic location, experience, and qualifications. Cybersecurity Awareness Notice In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment.