Clinical Pharmacist jobs at BlueCross BlueShield of Tennessee - 31 jobs

Ambulatory Care Clinical Pharmacist- 9 Month Temporary Position
Careoregon 4.5
Remote
--------------------------------------------------------------- The Ambulatory Care Clinical Coordinator (pharmacist) is responsible for providing oversight of an assigned area (i.e., Care Coordination or Network Liaison). The pharmacist needs to demonstrate consistent application of knowledge and skills related to pharmacy benefits, quality measures, and other initiatives in order to communicate, partner, and deliver appropriate, safe, efficient, and cost-effective patient care as part of a multidisciplinary team. Responsibilities include supporting the patient-centered medical home, incorporating principles of population-based medicine, expanding and coordinating the expansion of pharmaceutical care services to patients across the health-system through primary care clinics, community pharmacies, or other designated environments. Care Coordination: This position is responsible for coordinating effective use of the pharmacy benefit by delivering clinical and educational interventions designed to improve pharmaceutical care. Network Liaison: This position is responsible for aligning the clinical pharmacist network with CareOregon strategic goals and aiding the advancement of the practice of clinical pharmacy. This is a 9-month temporary position. Estimated Hiring Range: $151,965.00 - $185,735.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Develop and conduct quality improvement programs related to the pharmacy program. Develop and implement clinical educational programs to improve drug utilization and quality. Develop and conduct educational initiatives to improve prescribing patterns for quality and/or cost opportunities to support sustainable cost trends with the highest quality. Develop and critically evaluate pharmacy claim data analysis/reports in support of specific projects or program objectives. Develop and conduct retrospective drug use reviews. Leading the design, development, and implementation of quality improvement initiatives related to the pharmacy program will be an important aspect of this position. Review medication prior authorization requests and appeals as assigned. Review and refine policies and procedures regarding Pharmacy Department functions including medication therapy management, DUR programs, medication prior authorization, and others as applicable. Use an evidence-based process to perform new drug reviews, and to develop formulary recommendations and drug use criteria for the Pharmacy & Therapeutics Committee and other pharmacy program activities as assigned. Assess, review and respond to federal and state regulatory requirements/audits of the pharmacy benefit. Consult with clinicians and pharmacists to resolve pharmacy benefit issues. Precept pharmacy students and residents. Care Coordination Critically evaluate drug therapy regimens for patients enrolled in the care coordination program and assist with developing treatment plans. Provide medication therapy management (MTM) services. Utilize technology platforms to document and to meet MTM objectives. Monitor MTM objectives and high-risk population outcomes in partnership with the pharmacy benefit coordinator to provide oversight. Perform medication reviews and other tasks as assigned to meet plan quality metrics. Experience and/or Education Required Minimum Graduate of an accredited pharmacy program Current (or eligible) unrestricted licensure as a pharmacist in the state of Oregon Advanced pharmacy training (PharmD, residency, fellowship, board certification or master's degree in related discipline) Practical experience with minimum 2 years as a clinical pharmacist in pharmaceutical care management in an ambulatory care or other clinical setting (which can include residency experience) Preferred Previous experience in managed care and project management PGY1 residency training Knowledge, Skills and Abilities Required Knowledge Knowledge of the principles of managed care, pharmacy benefit management, pharmaceutical reimbursement, and pharmaceutical utilization Must have comprehensive, clinical pharmaceutical knowledge base Skills and Abilities Ability to critically evaluate clinical pharmaceutical and medical literature and apply principles of evidence-based medicine Ability to design and review pharmacy claims analysis/reports according to specific project requirements Must be highly motivated and have the ability to work independently Excellent organizational, project management, and time-management skills Excellent written and verbal communication skills Excellent customer service skills Ability to work with diverse groups Ability to manage multiple tasks Ability to negotiate, problem-solve, and consensus-build Basic word processing, spreadsheet, and database skills Propose and implement process improvements Meet deadlines for completion of workload Maintain agreed upon work schedule Demonstrate cooperation and teamwork Provide cross-training on specific job responsibilities Meet identified business goals that contribute to departmental goals Follow established departmental policies and procedures Perform other duties and projects as assigned Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Ability to lift, carry, push, pull and/or pinch small objects for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
$152k-185.7k yearly Auto-Apply 10d ago

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Clinical Program Pharmacist Prin- REMOTE
Prime Therapeutics 4.8
Remote
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting TitleClinical Program Pharmacist Prin- REMOTEJob Description The Principal Clinical Program Pharmacist Prin is responsible for implementing the strategy and developing clinical product(s). This role is responsible for keeping the product(s) competitive by understanding market problems, executing the product roadmap, and maintaining clinical criteria. The role requires routine interaction with leadership regarding the product strategy and must collaborate with other departments to ensure the strategy is executed as established. Responsibilities Develop and manage complex clinical product initiatives including clinical criteria Gather, analyze, and synthesize market information, clinical guidelines and member claims data to support clinical product management initiatives, products and strategies Coordinate, launch and implement new products, product enhancements, and process improvements across all stakeholders Represent the Clinical department as a strategic partner during customer requirement sessions Responsible for regulatory (URAC/NCQA, CMS, state law) oversight and external representation of the department Validate the accuracy of clinical product information and set up; may include user acceptance testing of applications and programs Establish and maintain cross-functional partnerships with leaders to drive informed decisions and successful execution of initiatives May be required to routinely collaborate and interact with client partners Other duties as assigned Minimum Qualifications Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree Current pharmacist license in good standing with State Board of Pharmacy 3 years of relevant work experience in a retail, hospital, clinical and/or managed care setting, including at least 2 years of work experience in a clinical and/or managed care setting Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications Microsoft Excel and Word proficiency Proven experience working in regulated environment Ability to work in ambiguous role with undefined parameters Exceptional relationship and communication skills; excellent written, verbal and presentation skills with the ability to convey complex ideas to diverse audiences Strong analytical and problem-solving skills with attention to detail and quality Ability to work on multiple projects simultaneously under pressure with strict timelines Ability to develop process efficiencies Ability to work well in team environment Preferred Qualifications Experience in cross-functional departmental collaboration Broad experience in or exposure to the Pharmacy Benefit Management (PBM) business Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $124,000.00 - $211,000.00 based on experience and skills.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.
$124k-211k yearly Auto-Apply 2d ago
Clinical Utilization Management Pharmacist
Peak Health 4.1
Remote
Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. Reporting to the Manager of Clinical Pharmacy, the Clinical Utilization Management Pharmacist is primarily responsible for performing drug utilization review for initial determinations and/or appeals for our ASO clients, Medicare Advantage plan, and any future lines of business as well as collaborating as an integral member of the pharmacy team. The responsibilities of this position also include serving as a subject matter expert for pharmacy utilization management in addition to ensuring the timely execution of all drug reviews in compliance with accreditation and regulatory standards. In addition, the Clinical Utilization Management Pharmacist will work with our Medical Director and Clinical Formulary team to review any specialty medication requiring a specialty consult as defined by our formulary team and identify any utilization review trends and areas of improvement that need to be addressed. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Must possess current and unrestricted license to practice pharmacy issued by state of residence. EXPERIENCE: 1. Three (3) years of experience as a pharmacist in a clinical setting. 2. Two (2) years of managed care experience. PREFERRED QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Specific knowledge of CMS regulations, HIPAA and regulatory environment. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Make prior authorization and step therapy determinations for drug utilization reviews based upon available clinical evidence and supporting documentation for all lines of business. 2. Participate in the appeals process for drug reviews for all lines of business. 3. Own the operational execution of the drug utilization review process. 4. Serve as an inter-departmental subject matter expert for utilization management as it relates to drug reviews. 5. Work with the Manager of Clinical Pharmacy to ensure the timely execution of all drug reviews in compliance with accreditation and regulatory standards 6. Work with the Manager of Clinical Pharmacy and Medical Directors to identify review trends and policy needs that need to be addressed. 7. Work with the Manager of Clinical Pharmacy and Director of Clinical and Technical Integration to identify and escalate operational and technical issues as they relate to drug utilization management reviews that need to be addressed. 8. Assist with internal and operational policy needs as they related to drug utilization management review. 9. Work with the Manager of Clinical Pharmacy to resolve questions and disputes from our clients and participating providers regarding drug review determinations. 10. Work with Medical Directors and formulary team to review and make recommendations on specialty drugs requiring a specialty consult as defined by our organization. 11. Assist in monthly analysis of claims data to assess effectiveness of current formulary and utilization management strategies. 12. Serve as a clinical pharmacy preceptor for residents and rotational pharmacy students as needed. 13. Assist in creation of training materials for utilization management operational processes as needed. 14. Assist in creation of clinical development tools for education as it relates to utilization review decision making as needed. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Ability to stand and walk short distances for eight or more hours. 2. Frequent bending, stooping or stretching. 3. Ability to lift 30 pounds and push 50 pounds. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Standard office environment. 2. Some travel may be required to offsite meetings. SKILLS AND ABILITIES: 1. Ability to work under stressful working conditions. 2. Ability to handle and maintain confidential information. 3. Ability to work cooperatively as a team member with articulate communication and presentation skills. 4. Ability to work in a fast-paced and rapidly changing environment. 5. Ability to work proactively and independently to research and resolve issues. 6. Extensive working knowledge of Microsoft Office applications (Excel and Access). Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Exempt) Company: PHH Peak Health Holdings Cost Center: 2405 PHH Medication Management
$56k-102k yearly est. Auto-Apply 4d ago
Clinical Pharmacy Technician Sr - Remote
Prime Therapeutics 4.8
Remote
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting TitleClinical Pharmacy Technician Sr - RemoteJob Description Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria. Responsibilities Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists. Researches, resolves and documents prior authorization outcomes in pharmacy system. Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists. Escalates requests to Pharmacist when request requires extensive clinical review or denial. Monitors telephone system to ensure adequate staffing to maintain client services levels. Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices. Demonstrates, advocates and reinforces a positive team environment. Other duties as assigned. Minimum Qualifications Education Level GED High School Required CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy 2+ years Pharmacy Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications Must have an active pharmacy technician licensure or registration in accordance with state requirements. If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT). In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT). Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting. In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.). Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite. Excellent written and verbal communication skills. Ability to follow clinical criteria and instructions to approve prior authorization requests. Minimum of 2 years dispensing or retail experience required, or equivalent internal training will be substituted. Ability to identify and trouble-shoot problematic issues. Preferred Qualifications Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail. Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.
$19.2-28.9 hourly Auto-Apply 2d ago
Clinical Pharmacy Specialist - Evernorth - Onsite - Per Diem
Cigna Group 4.6
Thonotosassa, FL jobs
This Clinical Pharmacy Specialist and is responsible for facilitating full cycle pharmaceutical care related to intravenous homecare patients. This position requires a current and active pharmacist license that is in good standing with the Board of Pharmacy. Schedule Every Friday is the preferred scheduled day for this role between 11am and 8pm ET and weekend on call Responsibilities Safely and correctly compound sterile medications and infusions for the home, outpatient clinics, skilled nursing facilities and physician/clinic environments. Initiate infusion therapies with successful on-going evaluation of care and completion of required documentation relative to processing therapies, both fiscal and legal. Responsible for understanding of, compliance with and participation in Quality Assurance, Performance Improvement and accreditation guidelines ensuring achievement of excellence in quality patient care. Assist with the referral process including but not limited to: provision of medical information to patients and care givers relative to home infusion therapy; assistance in the teaching of patients prior to discharge to home; and coordination of deliveries with nursing and support services. • Be actively involved in the education and in servicing of licensed health care professionals who perform services relative to the therapies provided by the home infusion center. Act as pharmacist in charge while on duty. Maintain working knowledge of all equipment and supplies necessary to administer therapies in the home or outpatient setting. Responsible for knowing and adhering to all home infusion center and company policies and procedures. Participate in inventory control, ordering, warehouse organization, packing/shipping, equipment maintenance and hazardous waste control. Responsible for emergency on-call duties on weekends and weeknights as required by center scheduling. Learn and utilize all computer programs necessary for the successful review, authorization, preparation, dispensing and management of home infusion center patients. Remain familiar with literature, references and resources for therapies and care of patients serviced by the home infusion center. Maintains the confidentiality of patients and their personal information at all times. Other duties as assigned. Qualifications Proficiency in Microsoft Suite and pharmacy software program Active Pharmacist license in good standing with Board of Pharmacy Experience in intravenous therapy Strong clinical knowledge Good verbal and written communication skills Ability to work in a team environment and cooperate with all departments within the home infusion center Requirements BS in Pharmacy or PharmD Current and licensed pharmacist with the Florida Board of Pharmacy Must be in good standing with all State Boards of Pharmacy where licensure is presently or previously has been active Meet State Board of Pharmacy and accreditation organization requirements by obtaining continuing education needed to maintain license Two years of experience in intravenous therapy in a hospital or in a home infusion setting that includes parenteral admixtures and patient clinical management Teaching experience with nurses and clients Must be flexible with work schedule and emergency call duty 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. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. 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. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$89k-121k yearly est. Auto-Apply 8d ago
Staff Pharmacist- Fulfillment - Accredo - Warrendale, PA
Cigna 4.6
Fernway, PA jobs
Accredo Specialty Pharmacy, part of Evernorth Health Services, is seeking a Staff Pharmacist to join their team in Warrendale, PA. This role is onsite at our office in Warrendale, PA. This role is worksite dependent and can only be performed onsite. This position has a 7-week rotating schedule of (4) 10- hour shifts Monday through Friday 9:00 am -8:00 pm ET including a 1-week On Call rotation approximately 4 times per year. For more than 30-years, Accredo has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others. POSITION SUMMARY As a Staff Pharmacist with Accredo, you will be responsible for monitoring and assuring compliance to State and Federal Rules and Regulations, FDA requirements, manufacturer contractual Adverse Event and Product Complaint clinical requirements and completing general Quality Assurance Checks. ESSENTIAL FUNCTIONS * Provide oversight and quality assurance to pharmacy technicians. * Interpret physicians' or prescribers' prescriptions. * Verify and confirm validity of controlled substances. * Verify prescription information entered in the system by data entry or order entry. * Back up other pharmacists as needed, perform additional duties as assigned by management, or train less experienced pharmacists. QUALIFICATIONS * Graduate of ACPE Accreditation School of Pharmacy with a B.S. Pharmacy or Pharm.D, degree. * 1+ years relevant experience. * Current resident pharmacist license in good standing. * Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues. * Good oral and written communication skills. * Ability to read and interpret prescriptions. * Strong focus on customer service, quality and accuracy. * Ability to manage timelines and meet tight client deadlines. * Ability to adapt in a changing environment. * Ability to work a flexible schedule for peak volume times. 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. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$104k-129k yearly est. Auto-Apply 52d ago
Fulfillment Pharmacist- Greensboro, NC (Accredo)
Cigna Group 4.6
Greensboro, NC jobs
This role is onsite at our office in Greensboro, NC on Gallimore Dairy Road. We are located very close to the airport. The Staff Pharmacist plays a critical role in providing pharmaceutical care in a closed door facility, focusing on accurate dispensing, medication management, and compliance with regulatory standards. This position requires good problems solving skills, adaptability, good communication skills, critical thinking skills, as well as organizational and leadership abilities. The Staff Pharmacist works collaboratively within a team of pharmacy professionals to ensure the safe, effective, and timely delivery of medications. Key Responsibilities Review and interpret physician orders and prescriptions for accuracy, safety, and appropriateness. Dispense medications in accordance with facility protocols and federal, state, and local regulations. Perform medication checks, including drug interaction and allergy screening, prior to dispensing. Supervise pharmacy technicians and support staff, providing guidance and oversight. Ensure proper documentation of all pharmacy activities and maintain accurate medication records. Monitor inventory levels, conduct audits, and assist in the ordering and storage of pharmaceuticals. Adhere to the implementing of policies and procedures to enhance pharmacy operations and patient safety. Maintain compliance with HIPAA and other patient privacy regulations. Participate in ongoing professional development and training activities. Qualifications Doctor of Pharmacy (PharmD) degree or Bachelor of Science in Pharmacy from an accredited institution. Current and unrestricted pharmacist license in the state of operation. Strong knowledge of drug therapies, compounding practices, and pharmacy law. Excellent attention to detail and organizational skills. Effective communication and interpersonal abilities to include good oral and written communication skills. Proficiency with pharmacy information systems and technology. Ability to work collaboratively in a team-oriented environment. Advanced problem solving skills and the ability to work with other professionals to resolve issues. Strong focus on customer service, quality and accuracy. Ability to adapt in a changing environment and manage tight timelines. Ability to work flexible schedule during peak volume hours. Physical and Working Conditions Closed door pharmacy environment with no direct interaction with the public. May require standing for extended periods and some lifting of pharmaceutical supplies. Work hours are primarily 8 am to 5 pm, including on-call shifts monthly 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. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$108k-134k yearly est. Auto-Apply 11d ago
Fulfillment Pharmacist- Greensboro, NC (Accredo)
The Cigna Group 4.6
Greensboro, NC jobs
**This role is onsite at our office in Greensboro, NC on Gallimore Dairy Road. We are located very close to the airport.** The Staff Pharmacist plays a critical role in providing pharmaceutical care in a closed door facility, focusing on accurate dispensing, medication management, and compliance with regulatory standards. This position requires good problems solving skills, adaptability, good communication skills, critical thinking skills, as well as organizational and leadership abilities. The Staff Pharmacist works collaboratively within a team of pharmacy professionals to ensure the safe, effective, and timely delivery of medications. Key Responsibilities Review and interpret physician orders and prescriptions for accuracy, safety, and appropriateness. Dispense medications in accordance with facility protocols and federal, state, and local regulations. Perform medication checks, including drug interaction and allergy screening, prior to dispensing. Supervise pharmacy technicians and support staff, providing guidance and oversight. Ensure proper documentation of all pharmacy activities and maintain accurate medication records. Monitor inventory levels, conduct audits, and assist in the ordering and storage of pharmaceuticals. Adhere to the implementing of policies and procedures to enhance pharmacy operations and patient safety. Maintain compliance with HIPAA and other patient privacy regulations. Participate in ongoing professional development and training activities. Qualifications Doctor of Pharmacy (PharmD) degree or Bachelor of Science in Pharmacy from an accredited institution. Current and unrestricted pharmacist license in the state of operation. Strong knowledge of drug therapies, compounding practices, and pharmacy law. Excellent attention to detail and organizational skills. Effective communication and interpersonal abilities to include good oral and written communication skills. Proficiency with pharmacy information systems and technology. Ability to work collaboratively in a team-oriented environment. Advanced problem solving skills and the ability to work with other professionals to resolve issues. Strong focus on customer service, quality and accuracy. Ability to adapt in a changing environment and manage tight timelines. Ability to work flexible schedule during peak volume hours. Physical and Working Conditions Closed door pharmacy environment with no direct interaction with the public. May require standing for extended periods and some lifting of pharmaceutical supplies. Work hours are primarily 8 am to 5 pm, including on-call shifts monthly 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. **About Evernorth Health Services** Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
$108k-134k yearly est. 60d+ ago
Specialty Pharmacy Administrator
Allied Benefit Systems 4.2
Chicago, IL jobs
This position acts as a liaison between the retail and specialty pharmacy and the prescribers to document, submit, communicate outcomes and appeals. The Specialty Pharmacy Administrator (Specialty Rx Administrator) manages all pharmacy and medical prior authorization requests. They will assist all members who express financial concerns regarding their medications as well as communicate escalations as appropriate. ESSENTIAL FUNCTIONS Collect and review all submitted records related to pharmacy and/or medical prior authorization requests when the queue exceeds normal capacity Arrange single case agreements, negotiate pricing, accurately process claims, and update all notes within the member's associated QicLink page Execute, manage, and provide on-going support of single case agreements Assist and collaborate with Customer Service to improve processes, communications, and service between members, facilities, and vendors Submit member referrals to third-party vendors managing specialty carve-out programs Serves as liaison for external vendors when implementing specialty carve-out programs Reviews current and newly requested vendor plan language to understand impact with governmental regulations Ensure ongoing knowledge and compliance with all contracts beyond initial implementation and throughout the full revenue cycle Collaborate with Plan Building, Customer Service, and other internal departments on the development and implementation of policies and group plan language related to a vendor Management of escalated questions and status updates related to vendor relationships for the Client Executive, Client Service, and Customer Service teams Other duties as assigned EDUCATION Bachelor's degree or equivalent work experience required. REQUIRED SKILLS AND ABILITIES At least 5 years of professional experience including comprehension of pharmacy and medical benefits, specialty medications, j-codes and their administration, limited distribution drugs as well as specialty pharmaceutical manager selection required. Prior authorization experience required. Knowledge of medication use in RA, transplant, Hepatitis C, infectious disease, and or oncology preferred. Excellent verbal and written communication skills. Excellent organizational skills and attention to detail. Excellent time management skills with a proven ability to meet deadlines. Strong analytical and problem-solving skills. Ability to prioritize tasks and to delegate them when appropriate. Ability to function well in a high-paced and at times stressful environment. Proficient with Microsoft Office Suite or related software. COMPETENCIES Job Knowledge Time Management Accountability Communication Initiative Customer Focus PHYSICAL DEMANDS This is a standard desk role - long periods of sitting and working on a computer are required. WORK ENVIRONMENT Remote Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. Protect Yourself from Hiring Scams Important Notice About Our Hiring Process To keep your experience safe and transparent, please note: All interviews are conducted via video. No job offer will ever be made without a video interview with Human Resources and/or the Hiring Manager. If someone contacts you claiming to represent us and offers a position without a video interview, it is not legitimate. We never ask for payment or personal financial information during the hiring process. For your security, please verify all job opportunities through our official careers page: Current Career Opportunities at Allied Benefit Systems Your security matters to us-thank you for helping us maintain a fair and trustworthy process!
$101k-128k yearly est. 3d ago
Weekend Part-Time Staff Pharmacist - CO/NV - Evernorth
Cigna Group 4.6
Denver, CO jobs
Part‑Time Staff Pharmacist - CO/NV The Part‑Time Staff Pharmacist, based in a Cigna office in Denver, CO or Las Vegas, NV, provides telepharmacy services to multiple hospital clients across various states. This role enhances clinical team performance, supports quality patient care, and ensures safe and compliant medication practices. This part‑time position includes evening, overnight, and/or weekend shifts. Shifts available: Saturday and/or Sunday: 6:00 AM - 6:00 PM PST Possible other shifts available: Monday-Friday: 12:30 PM - 8:30 PM PST Monday-Friday: 2:00 PM - 9:00 PM PST Monday-Friday: 7:30 PM - 6:00 AM PST Responsibilities: Telepharmacy Perform remote order entry, order verification, drug verification, and patient/staff counseling. Support multiple clients and operate within various pharmacy information systems (PIS). Clinical Excellence Provide proactive clinical pharmacy services and adhere to all client‑specific and Cigna policies. Deliver drug information and therapeutic recommendations, including dosing adjustments, interactions, compatibilities, and infusion guidance. Maintain working knowledge of IV fluids, TPN, narcotic/cardiac drips, IV antibiotics, chemotherapy, and more. Understand considerations for special populations (pediatric, geriatric, pregnant/nursing, renal/hepatic impairment, HIV). Counsel patients, nurses, and medical staff on safe medication use. Investigate and resolve medication variances within 48 hours. Operational Excellence Learn and work in multiple hospital pharmacy systems. Obtain and maintain multiple state pharmacist licenses. Document orders, interventions, and recommendations in PLRX by end of shift. Ensure compliance with all applicable pharmacy laws, regulations, and internal policies. Technical Excellence Perform basic troubleshooting during system or connectivity issues. Work effectively with VPNs, PIS platforms, automation systems, and common software (Microsoft Office, Snagit, etc.). Training & Development Participate in ongoing training, including clinical updates, PIS enhancements, and policy changes. Maintain all required access credentials, licenses, and reciprocity. Productivity Achieve and maintain company productivity metrics. Qualifications: B.S. in Pharmacy required, PharmD preferred. Active and in good standing Colorado or Nevada pharmacist license. Additional state licenses preferred (AL, LA, MS, MI, SC, NY). 2+ years of inpatient hospital experience preferred. Strong written and verbal communication skills. Demonstrated customer service skills. Knowledge of formulary management and P&T procedures. Familiarity with client/server applications. Proficiency in MS Office, Google Drive, internet, and email. 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.For this position, we anticipate offering an hourly rate of 54 - 91 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. 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. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$107k-133k yearly est. Auto-Apply 16d ago
Staff Fulfillment Pharmacist- Evening Shift- Accredo - Whitestown, IN
The Cigna Group 4.6
Indianapolis, IN jobs
The Staff Pharmacist is responsible for verifying and dispensing medications within corporate and regulatory guidelines. The Staff Pharmacist will track order status. The Staff Pharmacist may also train less experienced pharmacists. This position will require product verification and the ability to be flexible. Shift: 1:00 PM - 9:30 PM - Monday-Friday **ESSENTIAL FUNCTIONS** + Provide oversight and quality assurance to pharmacy technicians. + Interpret physicians' or prescribers' prescriptions. + Verify and confirm validity of controlled substances. + Verify prescription information entered in the system by data entry or order entry. + Back up other pharmacists as needed, perform additional duties as assigned by management, or train less experienced pharmacists. **QUALIFICATIONS** + Current resident pharmacist license in good standing. + Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues. + Good oral and written communication skills. + Ability to read and interpret prescriptions. + Strong focus on customer service, quality and accuracy. + Ability to manage timelines and meet tight client deadlines. + Ability to adapt in a changing environment. + Ability to work a flexible schedule for peak volume times. This position supports closing operations. 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. **About Evernorth Health Services** Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
$105k-130k yearly est. 60d+ ago
Home Infusion Staff Pharmacist - Longwood, FL
Cigna Group 4.6
Orlando, FL jobs
As a Staff Pharmacist, you will play a key role in delivering safe, high‑quality pharmaceutical care to home infusion and outpatient patients. You will compound sterile medications, support therapy management, collaborate with healthcare teams, and ensure compliance with accreditation and regulatory standards. Your work directly enhances patient outcomes and strengthens the overall quality of care. Available Schedule: Monday through Friday: 11AM-8PM CST with weekend and on-call rotation Responsibilities Compound sterile medications and infusions accurately for home, outpatient, long‑term care, and clinic settings. Initiate and manage infusion therapies while completing required clinical and legal documentation. Participate in Quality Assurance and Performance Improvement initiatives to support high standards of care. Educate patients and caregivers about infusion therapies and support their transition to home care. Provide clinical education and support to licensed healthcare professionals involved in infusion therapy. Serve as pharmacist‑in‑charge while on duty, ensuring operational and regulatory compliance. Maintain knowledge of equipment, supplies, and processes needed for safe therapy administration. Follow all pharmacy and home infusion center policies and procedures. Participate in inventory management, ordering, warehouse organization, equipment maintenance, and hazardous waste processes. Participate in on‑call rotation for after‑hours clinical support. Utilize pharmacy systems to review, authorize, prepare, dispense, and manage home infusion therapies. Maintain familiarity with clinical literature, references, and therapy guidelines. Protect patient confidentiality and comply with all privacy regulations. Perform other duties as assigned. Qualifications Bachelor of Science in Pharmacy required. Doctor of Pharmacy (PharmD) preferred. Active pharmacist license in good standing with the Florida Board of Pharmacy. Completion of required continuing education to maintain licensure. Experience in intravenous therapy in hospital or home infusion environments preferred Experience with parenteral admixtures and clinical patient management. Teaching experience with nurses, patients, or caregivers. Strong clinical knowledge and familiarity with infusion therapy literature. 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. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. 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. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$94k-117k yearly est. Auto-Apply 6d ago
Formulary Operations Pharmacist - Medicare
Capital Rx 4.1
Remote
About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi , the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Position Summary: The Formulary Operations Pharmacist - Medicare is responsible for providing operational support for the evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding of Medicare Part D formulary management processes and related CMS rules and regulations. Position Responsibilities: Maintain standard and custom formularies for the Medicare line of business in accordance with CMS Medicare guidelines Support development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists Lead and support preparation of monthly and annual files for CMS formulary submissions, member formulary drug lists and look up tools, and utilization management criteria Evaluate drugs/drug classes, make formulary positioning and utilization management recommendations, and update formulary management strategies and associated adjudication requirements to operationalize Evaluate appropriateness of and operationalize custom client formulary and benefit change requests within the formulary and adjudication platform Support comprehensive testing of client formulary and benefit elections Provide cross functional support for claim troubleshooting within the adjudication platform Monitor and analyze regulatory and legislative requirements for Medicare Support development of project plans to meet new CMS requirements, and support cross functional teams with implementation of programs to meet requirements Lead formulary change processes within URAC/NCQA/CMS guidelines Pharmacy and Therapeutics (P&T) Committee participation as an ad hoc member Conduct formulary reviews and develop drug monographs based on a rotation of clinical pharmacists Maintain and update the Capital Rx pharmaceutical pipeline, as needed Develop clinical criteria for review as needed Support CMS formulary administration audits Support quality improvement projects as needed Support Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed Support general business needs and operations, as needed Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. Minimum Qualifications: Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performance Current, unrestricted registered pharmacist license(s) Residency/fellowship preferred 2-3 years of formulary experience working for a health plan or PBM preferred 2-3 years of Medicare experience preferred Knowledge of formulary development and maintenance processes Knowledge of highly managed specialty medications/strategy Knowledge of rebate and financial implications of formulary strategies Experience working with large datasets preferred Ability to independently identify, research, and resolve issues Ability to balance multiple complex projects simultaneously Ability to work extended hours, weekends, and holidays consistent with industry demands Exceptional written and verbal communication skills Extremely flexible, highly organized, and able to shift priorities easily Attention to detail & commitment to delivering high quality work product Microsoft office suite with emphasis on Microsoft excel proficiency required #LI-BC1 Salary Range$125,000-$135,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at *********************************************
$125k-135k yearly Auto-Apply 1d ago
Pharmacist, Home Infusion - Evernorth
Cigna 4.6
Pittsburgh, PA jobs
As a dedicated pharmacy professional, you will ensure safe, cost‑effective medication therapy that supports optimal patient outcomes. You will also contribute to the development of current and future healthcare practitioners through education, while supporting drug‑related research and advancing high‑quality pharmaceutical care. Responsibilities * Interpret and evaluate physician medication orders to accurately prepare, calculate, and dispense medications in accordance with the Pennsylvania Pharmacy Practice Act, Federal Drug Laws, and other regulatory standards. * Identify and report suspected adverse drug reactions in a timely and accurate manner. * Support formulary stewardship by minimizing non‑formulary use, applying therapeutic interchange protocols, and promoting evidence‑based drug therapy decisions. * Review and maintain patient medication records to monitor allergies, drug interactions, and therapeutic duplications while processing and verifying orders. * Organize and support daily pharmacy operations, assisting with oversight and guidance of pharmacy technicians, aides, interns, and other personnel. * Ensure adherence to all regulatory requirements, professional pharmacy standards, and hospital quality management policies. * Communicate effectively with physicians, nurses, and care teams to clarify medication orders and support optimal care decisions. * Provide drug information, education, and support to healthcare professionals and pharmacy students. * Utilize available technology, including pharmacy information systems and clinical databases, to support accurate and efficient pharmaceutical care. * Process and verify prescription orders in compliance with state and federal requirements. * Participate in rotating shifts, including evenings, weekends, on‑call responsibilities, and holidays. Required Qualifications * Bachelor of Science in Pharmacy or Doctor of Pharmacy (PharmD) from an accredited school of pharmacy. * Pennsylvania pharmacist license. Preferred Qualifications * 3+ months of hospital pharmacy experience. * Experience or familiarity with home infusion and IV admixture preparation. 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. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. 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. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$110k-136k yearly est. Auto-Apply 26d ago
Appeals Pharmacist
Capital Rx 4.1
Remote
About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi , the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit **************** Position Summary: Responsible for reviewing clinical coverage determination and appeals for different lines of business such as Commercial and Medicare. Knowledgeable in all aspects of coverage determination and appeals process and assist in meeting client expectations regarding efficiency and quality decision making. Position Responsibilities: Evaluate and review all appeals requests to render coverage determinations based on clinical criteria and medical necessity. Performs and handles inbound and outbound phone calls with physicians, healthcare providers and/or patients to facilitate appeal requests, answer inquiries, and resolve escalations. Collaborate with internal and external Medical Directors by providing appropriate clinical/medical data needed to perform clinical reviews per the health plan criteria. Interpret clinical guideline criteria and appropriately utilize clinical knowledge and resources when rendering approvals and denials on all levels of appeals. Perform peer to peer reviews with providers when requested. Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to providers. Provide detailed and thorough documentation in prior authorization cases, appeals cases, and overrides. Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times. Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements. Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities. Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies. Deliver extraordinary customer care and service by responding to questions concerning customer accounts in a fast paced, structured environment within established time frames. Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. Minimum Qualifications: Active, unrestricted, pharmacist license required 1+ years prior authorization review or appeals experience required Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven environment with shifting priorities Have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations Strong oral and written communication skills required Proficient in Microsoft Office Suite and experience using clinical resources (e.g. Micromedex, Lexicomp, Clinical Pharmacology) Preferred Qualifications: Experience working with Medicare appeals preferred Salary Range$120,000-$130,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at *********************************************
$120k-130k yearly Auto-Apply 7d ago
Staff Pharmacist- Accredo - Memphis, TN
Cigna Group 4.6
Memphis, TN jobs
Make a Lasting Impact as a Staff Pharmacist in Memphis, TN Join Accredo Specialty Pharmacy, part of Evernorth Health Services, where your expertise and compassion will help transform patient care. Located onsite in Memphis, TN, this second-shift role offers the opportunity to contribute meaningfully to our mission of delivering first-class care and services for over 30 years. This position is 2nd shift Monday through Friday 1:30 pm - 10 pm CT *Beginning January 2026, the shift would be Monday through Thursday (Friday off) 1:30 pm - 10:00 pm CT and Saturday 4 am - Noon CT. Responsibilities Ensure accurate and timely dispensing of patient orders by managing fulfillment operations workflow. Interpret physician prescriptions and compound medications in compliance with regulatory guidelines. Monitor drug therapies and recommend interventions to optimize patient outcomes. Lead and supervise pharmacy technicians, ensuring quality and compliance in pharmaceutical preparation. Maintain a safe and clean working environment by adhering to infection-control protocols and operational procedures. Stay informed on current and emerging legislation to advise management on necessary actions. Contribute to continuous improvement initiatives and team success through strategic problem-solving and collaboration. Required Qualifications Valid TN pharmacist license. Minimum of 1 year of experience in a pharmacy setting. BS in Pharmacy or PharmD Preferred Qualifications Graduate degree from an accredited pharmacy college recognized by the ACPE Experience in specialty pharmacy or fulfillment operations. 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. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$96k-119k yearly est. Auto-Apply 45d ago
Staff Pharmacist- Accredo - Memphis, TN
The Cigna Group 4.6
Memphis, TN jobs
**Make a Lasting Impact as a Staff Pharmacist in Memphis, TN** Join Accredo Specialty Pharmacy, part of Evernorth Health Services, where your expertise and compassion will help transform patient care. Located onsite in Memphis, TN, this second-shift role offers the opportunity to contribute meaningfully to our mission of delivering first-class care and services for over 30 years. **This position is 2nd shift Monday through Friday 1:30 pm - 10 pm CT** ***Beginning January 2026, the shift would be Monday through Thursday (Friday off) 1:30 pm - 10:00 pm CT and Saturday 4 am - Noon CT.** **Responsibilities** + Ensure accurate and timely dispensing of patient orders by managing fulfillment operations workflow. + Interpret physician prescriptions and compound medications in compliance with regulatory guidelines. + Monitor drug therapies and recommend interventions to optimize patient outcomes. + Lead and supervise pharmacy technicians, ensuring quality and compliance in pharmaceutical preparation. + Maintain a safe and clean working environment by adhering to infection-control protocols and operational procedures. + Stay informed on current and emerging legislation to advise management on necessary actions. + Contribute to continuous improvement initiatives and team success through strategic problem-solving and collaboration. **Required Qualifications** + Valid TN pharmacist license. + Minimum of 1 year of experience in a pharmacy setting. + BS in Pharmacy or PharmD **Preferred Qualifications** + Graduate degree from an accredited pharmacy college recognized by the ACPE + Experience in specialty pharmacy or fulfillment operations. 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. **About Evernorth Health Services** Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
$96k-119k yearly est. 52d ago
Pharmacist-In-Charge- Specialty Pharmacy Onsite Orlando - Evernorth
Cigna Group 4.6
Maitland, FL jobs
Join ProHealth as a Pharmacist In-Charge (PIC) at our Maitland, Florida location and lead pharmacy operations to ensure compliance, quality, and exceptional patient care. This role combines leadership with hands-on clinical and operational responsibilities, supporting a high-volume specialty pharmacy environment. Responsibilities Oversee pharmacy operations to maintain compliance with state board and regulatory requirements. Perform hands-on clinical and operational pharmacist duties to ensure smooth workflow. Develop and enforce site-level policies and procedures that promote safe and cost-effective medication use. Implement and monitor Key Performance Indicators (KPIs) for specialty pharmacy performance. Collaborate with physicians and healthcare teams to optimize drug therapy and patient outcomes. Manage prior authorizations, billing, and reimbursement processes for specialty medications. Ensure accurate documentation in EMR systems and CarepathRx's DromosPTM platform. Provide clinical consultations and therapeutic recommendations for complex patient cases. Lead and mentor clinical pharmacists and pharmacy students, fostering a culture of excellence. Maintain confidentiality and uphold CarepathRx's core values in all interactions. Qualifications Required: B.S. degree in Pharmacy or Doctor of Pharmacy (PharmD). Active Florida Pharmacist license and ability to register as PIC. Minimum 2 years of experience in specialty pharmacy services. Proficiency in Microsoft Suite and pharmacy software systems. Strong clinical knowledge and ability to manage complex therapies. Excellent communication, leadership, and organizational skills. Preferred: Certified Specialty Pharmacist (CSP) or willingness to obtain certification. Experience in health system specialty pharmacy operations. Multiple state pharmacist licenses or willingness to obtain additional licenses. Familiarity with pharmacoeconomic programs and performance improvement initiatives. 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. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. 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. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$96k-123k yearly est. Auto-Apply 9d ago
Staff Utilization Management Clinical Pharmacist (VSP/PT)
Humana 4.8
Nashville, TN jobs
**Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. **Location:** **Remote - United States** **Schedule: This is a VSP (Variable Service Provider) role. The hours will vary between 24-40 hours per week.** **The s** **hift for training will be 10:00AM-630PM ET.** **After training, a shift of either 11:00AM-730PM ET, 12:00PM-830PM, or 1:00PM-930PM will be assigned based on business need.** **Some weekend coverage may be required. Mandatory overtime during peak season.** **Job Description:** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes. **Use your skills to make an impact** **Required Qualifications:** + **Bachelor's degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy** + Active pharmacist license in the state of residence + Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid) + Self-directed with the ability to work effectively both independently and in a team environment + Strong problem-solving skills and the ability to foster collaborative solutions + High attention to detail with a strong work ethic focused on accuracy and productivity + Excellent verbal and written communication skills + Proficiency with computer systems, including but not limited to: + Microsoft Office Suite (Word, Excel, Outlook) + Clinical decision support tools (e.g., Micromedex, Lexicomp) + Pharmacy benefit management (PBM) platforms + Electronic health records (EHRs) + Passion for contributing to an organization focused on continuously improving the consumer experience **Preferred Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Interview Format** : As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **WAH Requirements:** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **SSN Statement:** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 1 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident. Application Deadline: 01-30-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$43k-74k yearly est. Easy Apply 2d ago
Staff Utilization Management Clinical Pharmacist (VSP/PT)
Humana 4.8
Montpelier, VT jobs
**Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. **Location:** **Remote - United States** **Schedule: This is a VSP (Variable Service Provider) role. The hours will vary between 24-40 hours per week.** **The s** **hift for training will be 10:00AM-630PM ET.** **After training, a shift of either 11:00AM-730PM ET, 12:00PM-830PM, or 1:00PM-930PM will be assigned based on business need.** **Some weekend coverage may be required. Mandatory overtime during peak season.** **Job Description:** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes. **Use your skills to make an impact** **Required Qualifications:** + **Bachelor's degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy** + Active pharmacist license in the state of residence + Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid) + Self-directed with the ability to work effectively both independently and in a team environment + Strong problem-solving skills and the ability to foster collaborative solutions + High attention to detail with a strong work ethic focused on accuracy and productivity + Excellent verbal and written communication skills + Proficiency with computer systems, including but not limited to: + Microsoft Office Suite (Word, Excel, Outlook) + Clinical decision support tools (e.g., Micromedex, Lexicomp) + Pharmacy benefit management (PBM) platforms + Electronic health records (EHRs) + Passion for contributing to an organization focused on continuously improving the consumer experience **Preferred Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Interview Format** : As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **WAH Requirements:** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **SSN Statement:** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 1 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident. Application Deadline: 01-30-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$41k-53k yearly est. Easy Apply 2d ago

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BlueCross BlueShield of Tennessee Clinical Pharmacist Jobs

Updated January 21, 2026

Clinical Pharmacist jobs at BlueCross BlueShield of Tennessee - 31 jobs

Ambulatory Care Clinical Pharmacist- 9 Month Temporary Position

Clinical Program Pharmacist Prin- REMOTE

Clinical Utilization Management Pharmacist

Clinical Pharmacy Technician Sr - Remote

Clinical Pharmacy Specialist - Evernorth - Onsite - Per Diem

Staff Pharmacist- Fulfillment - Accredo - Warrendale, PA

Fulfillment Pharmacist- Greensboro, NC (Accredo)

Fulfillment Pharmacist- Greensboro, NC (Accredo)

Specialty Pharmacy Administrator

Weekend Part-Time Staff Pharmacist - CO/NV - Evernorth

Staff Fulfillment Pharmacist- Evening Shift- Accredo - Whitestown, IN

Home Infusion Staff Pharmacist - Longwood, FL

Formulary Operations Pharmacist - Medicare

Pharmacist, Home Infusion - Evernorth

Appeals Pharmacist

Staff Pharmacist- Accredo - Memphis, TN

Staff Pharmacist- Accredo - Memphis, TN

Pharmacist-In-Charge- Specialty Pharmacy Onsite Orlando - Evernorth

Staff Utilization Management Clinical Pharmacist (VSP/PT)

Staff Utilization Management Clinical Pharmacist (VSP/PT)

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