This page tracks remote pharmacist openings that are location-eligible for West Virginia.
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• Assists in development and supervises the drug utilization and prior authorization review program. • Develops and implements pharmacy cost containment strategies tailored to the specific situations and patterns of the enterprise, specific regions, and large accounts. • Drafts pharmaceutical criteria and performs other activities in support of the enterprise prior authorization program. • Keeps up-to-date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, leadership, and clinical department as a subject matter expert (SME). • May be responsible for conducting the second level review for medical and pharmacy benefit medication prior-authorizations, exceptions, and medical necessity reviews submitted to the plan. • May be responsible for ensuring appropriate alignment of medical policies and configuration for claims processing and utilization management. • Performs other duties as assigned. • Prepares and presents reports, data and analyses on the utilization and cost trends for enterprise lines of business, specific regions, and large accounts. • Provides leadership and advice on developing and implementing pharmacy reimbursement, claims processing policies and procedures, and pharmacy vendor selection. • Reviews and interprets coverage across assigned line(s) of business to determine what type of review is required and works with requesting providers, corporate medical directors, and other internal staff, as appropriate, in determining whether a specific case presentation meets the criteria for approval according to the specific coverage criteria. • Serves as a liaison to individual pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers on pharmacy issues. • Supports pharmacy initiatives for member, provider, and client satisfaction. • Uses clinical knowledge and independent critical thinking skills towards interpreting criteria, policies, and procedures to make determinations on prior approval reviews and retrospective reviews and/or pharmacy consultations within case management. • Uses knowledge of the pharmacy and/or medical benefit to communicate with, and provide recommendations to Care Management nurses, social workers, and medical directors. • Uses knowledge of the pharmacy and/or medical benefit to ensure our members receive their medications in a timely fashion, avoiding delays in treatment.
• Answer inbound calls and return voicemails from members, delivering exemplary customer service and support. • Troubleshoot and resolve prescription-related issues for members whose plans utilize CVS or Carelon as the PBM. • Coordinate with providers’ offices and retail/mail-order pharmacies as needed to resolve claims processing, prior authorization, and medication access issues. • Document all actions, progress, and communication in the ticketing system and Acuity, updating ticket status in accordance with internal standards. • Conduct proactive member outreach, including but not limited to disruption list communications and follow-up calls. • Collaborate closely with Pharmacy Services team members and cross-functional departments to ensure timely resolution of pharmacy-related concerns. • Perform other duties as assigned.
AdhereHealth™: Empowering the Medication Journey with Omnichannel Support and Behavioral Science
• Performs telephonic comprehensive medication reviews • Updates patient profiles based on information gathered during the review • Reviews any Drug Therapy Problems to optimize patient’s drug therapy and minimize the potential for adverse drug reactions • Works with multidisciplinary team to enhance and develop our MedPro software. • Completes at least (2) two CMR’s per hour • Assists Clinical team in meeting proficiency and quality goals • Utilizes client formulary information and member specific benefits to guide appropriate medication recommendations • Maintains current on emerging trends that will educate clinical team, physicians and other prescribers
Sutter Health is an award-winning, not-for-profit health system headquartered in Sacramento, California. Comprised of a team of industry leading doctors, hospit
Role Description This position is available to work from home from within the Sutter Health Northern California footprint. Responsible for performing the appropriate processes to verify patient eligibility, coordinate benefits, ensure insurance coverage, and determine if prior authorization is needed for said order. If needed, obtains authorization and documents in the patient electronic medical record. Facilitates responses to patient inquiries regarding authorizations within turnaround standards. Qualifications - HS Diploma or GED - 1 year recent relevant experience Requirements - Medical terminology knowledge - Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge - Knowledge of medical terminology/anatomy - Ability to exercise discretion and make independent judgments, seeking review when decisions represent significant departure from established guidelines - Knowledge of Microsoft Office programs including Excel, Word or similar programs - Ability to maintain composure during challenging interpersonal interactions - Active listening skills; including interpersonal skills and telephone communication - Organizational skills with attention to detail and follow-up Benefits - Eligible positions include a comprehensive benefits package Company Description Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $27.50 to $34.37 / hour. The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
Role Description The Pharmacy Technician I supports the organization’s mission and purpose by providing front-line customer support for a diverse portfolio of customers. The incumbent will handle inbound telephone inquiries from Members, pharmacies, and Prescribers in our National Customer Care Center, and will consistently meet established productivity, schedule adherence, and quality standards. Work Arrangement: Remote Responsibilities - Provide real-time support to pharmacies with point-of-service inquiries - Educate prescribers on formulary and prior authorization processes - Enter customer data and other relevant information into our documentation tool - Assist members with pharmacy benefit inquiries - Adhere to standard operating procedures to ensure contact handling accuracy and operational effectiveness - Effectively communicate issues and resolutions to customers and appropriate internal staff Qualifications - Bachelor's degree or equivalent experience required - Minimum three (3) years of current/recent PBM and/or current/recent pharmacy experience required Requirements - Active/current National Pharmacy Technician Certification (NHA or PTCB) or ability to obtain one within the first six (6) months of employment is required Benefits - Flexible work solutions include remote options - Competitive pay - Paid Time Off (PTO), including holidays and volunteer events - Health insurance coverage for you and your dependents on Day 1 - 401(k) - Tuition reimbursement - And more
Role Description The Pharmacy Service Associate is responsible for performing daily, routine tasks in the pharmacy such as answering the phone, responding to customer requests, data entry, record maintenance, and other clerical duties. - Answers inbound calls to the Pharmacy - Communicates with Patients regarding their medication orders, including verifying order status - Responds to requests and communicates with Lincare Center staff regarding patient medication orders - Places medication refill order in computerized system at patient request - Assesses customer compliance with physician orders - Answers questions and provides customer education regarding products/services, within Board of Pharmacy Regulations - Submits requests for special orders as needed - Tracks medication packages in various vendor systems such as UPS - Researches order status and delivery at patient or center request - Inactivates patient accounts in computerized system - Processes patient address changes, ensuring accurate address information - Responsible for meeting specific performance objectives related to number of calls handled, orders processed, time on call, time entering information in computerized system, etc. - Complies with Board of Pharmacy rules and regulations Qualifications - High School Diploma or General Education Degree (GED), Required - Minimum of one-year clerical/office experience, required - Strong phone, verbal, and written communication skills - Problem-solver - Proficiency in Microsoft Office applications - Adequate typing (typically 30 -- 40 wpm) - Successfully complete Pharmacy Technician Training program and obtain Pharmacy Technician Registration within required timeframe - For Med4Home positions, Pharmacy Technician License is required in state of jurisdiction Benefits - Ongoing training and advancement opportunities - Comprehensive medical, dental, and vision coverage - Paid time off - Retirement savings - Tuition reimbursement - Generous employee referral program - Wide array of employee discounts
UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Pharmacist Location: Parkersburg United States Job type: Onsite Time Type: part Time Requisition number: 2345725 Job category: Pharmacy Job Description: Overtime status: Non-exempt Travel: No Opportunities with Genoa Healthcare. A career with Genoa Healthcare means you're part of a collaborative effort to serve behavioral health and addiction treatment communities. We do more than just provide medicine: we change lives for the better. People with serious mental or chronic illness - and those who care for them - have moving stories, and at Genoa we become their voice, their partner. Working as part of a coordinated care team, we partner with community-based providers and others to ensure that people with complex health conditions get the right medications and are able to follow their treatment plans. Our personalized services - in-clinic pharmacies, medication management and more - are leading the way to a new level of care. Genoa is a pharmacy care services company that is part of Optum and UnitedHealth Group's family of businesses. We are part of a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. Join us to start Caring. Connecting. Growing together. At OptumRx, a part of the UnitedHealth Group family of businesses, we're reinventing Pharmacy Benefit Management by taking Pharmacists out of a retail or hospital setting and letting them care for our members over the phone. It's a chance to work in a non-traditional setting as you consult with physicians regarding medications and overall wellness. Even better, you'll enjoy greater freedom and still have an opportunity to positively impact our members' lives. Primary Responsibilities: - Review requests for prescription prior authorizations - Oversee the activities of pharmacy technicians, pharmacy clerks and customer service advocates - Perform all duties and functions in compliance with state and Federal pharmacy laws and regulations - Support department quality assurance and improvement guidelines Success in this role will depend heavily upon your customer service skills and ability to thrive in a fast-paced, call center environment. You must also be able to work a variety of shifts based on need. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - BS in Pharmacy or Pharm D degree - Current and unrestricted pharmacist licensure (include state specific if required) - 1+ years of experience in a retail pharmacy setting - Demonstrated ability to work various shifts (as needed) Preferred Qualifications: - PBM or Managed Care experience - Call center experience UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 5, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good. Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed. Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $44.09 to $78.70 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
ArchWell Health aims to transform healthcare for seniors and focuses on quality care, empathy, and community outreach. The company fosters a collaborative cultu
Role Description The Pharmacy Technician is an important colleague of ArchWell Health Pharmacy Team. Reporting to the Clinical Pharmacist, the Pharmacy Technician will be providing direct patient care and collaborating with other healthcare team members in a virtual environment to optimize the pharmaceutical care for our patients. This individual will conduct patient outreaches per existing protocols and assist patients with navigating the medication use aspects, including reviewing components of their plan benefits. An ideal candidate will have a deep understanding of Medicare Advantage prescription benefits, possess strong attention to detail, and be driven by a passion for providing quality care to seniors. Duties/Responsibilities - Conduct telephonic outreaches and answer incoming calls regarding member’s medication use, including but not limited to medication adherence, refill request, and medication clarification. - Obtain member’s permission and place refill requests with pharmacies via phone or web systems. - Access medication adherence gap portals or lists and review member’s medical chart notes to determine appropriate action. - Review and process pharmacy refill requests, either via faxes, EMR routes, or direct incoming calls, per established protocol while meeting the expected turnaround time. - Collaborate with other pharmacy staff, providers, and their care teams as needed to resolve any issues or discrepancies related to medication use. - Ensure that all tasks are completed timely, documented accurately, and in accordance with regulations (including HIPAA) and organizational standards. - Attend staff meetings and provide input into current trends, process evaluation, and quality improvement. - Assist with other pharmacy departmental initiatives as they become available. - Additional duties, as assigned. Qualifications - Excellent customer service and communication skills, including telephone etiquette skills, active listening skills, and the ability to follow-through with patients or staff members. - Ability to work effectively and respectfully with colleagues and diverse populations including members, staff, providers, and family members. - High degree of emotional intelligence and integrity, resilient and focused work ethic, with adaptability to handle frequent changes with a positive attitude. - Self-starter with the ability to think creatively and work effectively. - Strong attention to detail and possessing good alpha/numeric data entry skills with minimal errors. - Intermediate proficiency in Microsoft Office Suite products including Word, Outlook and Excel plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software. - Ability to travel on occasion for company meetings. Requirements - High school diploma or equivalent education (GED) required. - Registered Pharmacy Technician with a state board of pharmacy. - A minimum of 2 years of experience in operational pharmacy benefits (health plan or PBM), clinic setting, high volume call center, or retail pharmacy. - eClinicalWorks or similar EMR experience. - Experience working with geriatric patients or a medication adherence program is a plus. - Bilingual in English/Spanish highly desired. Company Description ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities.
AlediumHR specializes in Telehealth, Health-Tech, Healthcare Support, Pharmaceutical, and Biomedical Recruiting.
Role Description AlediumHR is partnering with a forward-thinking telehealth organization that is redefining how men and women manage their health. This is not a generalist telehealth role. This is for experienced nurse practitioners who understand hormone therapy and want to practice at a high level. The Opportunity: - Seeking experienced, licensed Nurse Practitioners or APRNs with at least 1 year of experience in Hormone Replacement Therapy (HRT) for both men and women. - Part-time and full-time availability. - Providers work remotely and deliver high-impact care through a structured, technology-enabled telehealth model. Qualifications - Active NP or APRN license in a minimum of 8 U.S. states. - Active, unrestricted DEA license. - Ability to prescribe and manage controlled substances in compliance with federal and state regulations. Requirements - Minimum 1 year of hands-on Hormone Replacement Therapy experience. - Experience treating both male and female patients. - Comfort managing testosterone therapy, estrogen/progesterone therapy, adjunct wellness medications, and ongoing lab monitoring. - Strong understanding of endocrine health, preventative care, and optimization protocols. What You'll Do - Conduct structured virtual consultations for men and women seeking hormone optimization and wellness care. - Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans. - Initiate and manage HRT protocols, including appropriate prescribing and follow-up. - Provide patient education on risks, benefits, and long-term care strategies. - Maintain thorough, compliant documentation within telehealth platforms. - Collaborate with a clinical and administrative support team to ensure a seamless patient experience. Work Environment - Remote Flexibility: Work from home with scheduling options that fit your availability. Minimum of 30 hours weekly required. - Focused Practice Model: This is a specialized hormone and wellness platform. You will not be handling random urgent care visits or unrelated cases. - Operational Support: Administrative, tech, and compliance infrastructure are in place so you can focus on patient care. - Growth Environment: Join a high-growth telehealth organization expanding nationwide.
Leading nationwide provider of substance use treatment offering a full continuum of care. #FreedomFromAddiction
Role Description - Complete insurance verification and eligibility checks. - Collect and accurately document initial pre-certification/authorization information if available. - Initiates the process of obtaining a required referral/authorization if not obtained. - Work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue. - Proactively communicate issues involving customer service and process improvement opportunities to management. - Maintains excellent public relations with patients, patients’ families, and clinical staff. - Demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information. - Maintains knowledge of and reference materials for Medicare, Medicaid, and third-party payer requirements guidelines and policies. - Update the patient, physician's office, and any necessary parties regarding responses and outcomes of the prior authorizations. - Act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed. - May identify and assist patients with access to internal and external financial assistance programs. - May communicate to the patient and/or physician's office when authorization is not obtained, or services are not covered, and explains the potential financial responsibility. - Coordinates with patient, clinical team, and assistance programs to secure reimbursement or alternative covered options. - Manages incoming and outgoing calls, which may include other Advocate team members, departments, patients, insurance plans, and/or copay foundation/assistance programs. Qualifications - High School Graduate Requirements - Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background. - Demonstrate ability to identify and understand issues and problems. - Ability to problem solve in a high profile and high stress area. - Mathematical aptitude, effective communication, and critical thinking skills. - Ability to prioritize and organize workload. - Excellent verbal and written communication skills. - Demonstrated technical proficiency including experience with insurance authorization/eligibility tools, EPIC, Microsoft Office, Internet browser, and telephony systems. Benefits - Paid Time Off programs. - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability. - Flexible Spending Accounts for eligible health care and dependent care expenses. - Family benefits such as adoption assistance and paid parental leave. - Defined contribution retirement plans with employer match and other financial wellness programs. - Educational Assistance Program.
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