Peak Holdings LLC jobs - 5 jobs

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

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. Come join our Peak Health team at WVU Medicine as a Benefit Configuration Analyst contributing to the foundation for an innovative, new health plan. This position will report to the Benefits Configuration Leadership, playing a unique and important role in our mission to change healthcare for the better. This role will review, implement and test new plan designs as well as update existing benefit plans via business requirements while working with IT for technical solutions. The Benefits Team will analyze and update CPT, HCPC and ICD-10 coding along with ensuring compliance with CMS and other insurance governance agencies using expert data analysis. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Associate degree in health information, healthcare, or related field AND One (1) year of experience in health insurance, medical coding, claims processing or related field. OR 2. High School Diploma or equivalent AND Three (3) years of experience in health insurance, medical coding, claims processing or related field. PREFERRED QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Bachelor's degree in health information, healthcare, or related field. EXPERIENCE: 1. 6 years' experience in health insurance and benefit design. 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. Test and maintain health insurance benefit plans in the company's systems, ensuring accuracy and compliance with regulatory requirements. 2. Conduct regular audits and reviews of benefit configurations to identify discrepancies, inconsistencies, or errors. 3. Resolve configuration errors in a timely manner and document changes. 4. Work closely with IT teams to ensure seamless integration of benefit configurations into the company's technology platforms. 5. Maintain comprehensive documentation for benefit configuration, ensuring that processes and procedures are well-documented. 6. Evaluate and validate all medical billing codes, various coding services and align to accurate benefit coding. 7. Perform audits on all clinical documents and prepare coding to provide support to all services. 8. Perform research on various coding methods and facilitate all plans to resolve all discrepancies and coordinate with all clinical and non-clinical groups to manage documents according to required guidelines. 9. Administer review of professional billing systems and perform research to resolve all coding errors and evaluate all claims work queues. 10. Review procedure code master file and evaluate authenticity of all entries and evaluate all through efficient usage of codes. 11. Analyze and maintain all code master files for all inappropriate codes and inform staff for same and collaborate with staff to resolve all coding issues and ensure accuracy of same. 12. Perform testing of coding and policy changes via reports, claim adjudication and other testing software. 13. Manage and resolve all discrepancies in entry of codes and maintain knowledge on all procedural codes and reimbursement plans and prepare reports for all coding guidelines. 14. Maintain knowledge and compliance of CMS (Center for Medicare Services) guidelines and coding/billing processes. Ensure compliance with other insurance governance agencies. 15. Participate in and support all training in regard to new benefit designs or benefit changes as the result of CMS or other insurance regulations. 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. Prolonged periods of sitting and standing. 2. Visual strain may be encountered in viewing computer screens and written material. 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. Strategic and Independent thinking. 2. Demonstrated knowledge of federal and state insurance guidelines with CMS and others. 3. Excellent written and oral communication. 4. Demonstrated ability to build and retain relationships. 5. Proficiency with Microsoft Office. 6. Attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Exempt) Company: PHH Peak Health Holdings Cost Center: 500 PHH Administration

Job Summary: Peak Water Services is seeking a Field Services Lead to join our team. In this key role, you will coordinate and perform hands-on work across water and wastewater systems, ensuring optimal performance through field troubleshooting, repairs, equipment maintenance, and customer support. You will be working with a variety of utility infrastructure, including water distribution systems, wastewater collection systems, lift stations, pumps, electrical panels, and SCADA system. Essential Duties and Responsibilities: Analyze customer or company needs and develop daily work plans for yourself and field personnel. Maintain proactive communication with management, administrative staff, and sales teams. Coordinate and perform troubleshooting, repairs, and startup activities for utility systems and equipment. Review and interpret customer requirements, site layouts, and system documentation. Maintain strong working relationships with customers by resolving complaints, offering system improvements, and implementing long-term solutions. Ensure company vehicles and tools are accounted for, operational, and properly maintained. Oversee repairs, preventative maintenance, and performance checks on utility infrastructure. Operate and assist with equipment such as pumps, valves, instrumentation, SCADA interfaces, electrical panels, and telemetry systems. Complete detailed reports, work logs, service forms, and digital records. Track inventory, part usage, and maintenance actions consistently and accurately. Lead or mentor field personnel when needed. Promote a culture of safety, efficiency, and knowledge-sharing. Participate in ongoing education, training programs, and industry development opportunities Work Environment: Outside 80+% of the time Potable Water and Wastewater Treatment Plants Mobile service roll from the company vehicle Long-distance driving with occasional overnight travel (approximately 10%). Work Schedule and Benefits: This is a full-time hourly wage position. Regular performance reviews and merit-based raises Schedule details to be determined and subject to periodic changes. Paid holidays, vacation, sick time Matching 401(k) Health insurance Job Type: Full-time Benefits: 401(k) Dental insurance Vision insurance Health insurance Paid time off Tuition reimbursement Schedule: 10 hour shift People with a criminal record are encouraged to apply Qualifications Qualifications: Must be able to use general business software (Microsoft Office, Google Docs, Excel, Adobe Acrobat) and hardware (smartphone/tablet, notebook computer, scanner, etc.). Pumping systems troubleshooting and repair experience or the ability and drive to learn quickly is critical. Small to Medium water and sewer utility systems knowledge, troubleshooting ability, and equipment maintenance experience is preferred. Ability to obtain and maintain a DOT medical card and an unrestricted driver's license w/ acceptable MVR is required.

If you have the aptitude or knowledge to fix anything, can work alone and are self-sufficient and self-driven, this will be the perfect career path for you. Filter Tech Systems is looking for a mechanically-inclined individual with great trouble-shooting skills to install and maintain equipment in the field. -Qualifications of a Field Service Technician: A good Field Service Technician will possess a wide range of skills and aptitudes that can be utilized for field service work including: Dependable / Reliable Mechanically Inclined Self-Starter / Self-Motivated Takes pride in your work Takes ownership of your work Attention to Details Quality-minded Hard-Working Safety-conscious Willing to take initiative to learn and grow Skills that you need to possess or would like to learn include: Ability to understand and trouble shoot Low Voltage Circuitry Knowledge of AC & DC circuits Ability to read Blueprints and Electrical Control Panel Wiring Diagrams Instrumentation calibration and troubleshooting to include but not limited to: Ability to configure digital controllers and analyzers, set up pumps and VFDs, and set up automated valves and flow meters Good math skills The right person for this job will have either the knowledge and experience to do all of the above or the willingness to learn. *Valid Driver's License is required along with the ability to travel out of state* **Many of our job sites are out of town and some are even out of state. Traveling for installations and servicing will often include overnight stays near job locations, up to 3 nights/4 days out of town at a time. Often weeks will include leaving the office on Monday and not returning until Thursday evening - Company provides transportation, individual hotel room, and funds for dinner and expenses** Other weeks may include multiple single day trips and/or prep work in our office. *Not a remote position we are based out of Grand Junction, Colorado* -A Day in the Life of a Field Service Technician: Our field employees appreciate a 4-Day, 40-hour work week and a generous time off policy. We try to treat everyone like family and work to create a group of individuals that can function as a team. Our Field Service Technicians go to water treatment facilities, mostly in the Rocky Mountain West, and trouble shoot and repair valves, flow meters, transmitters, VFDs, sensors and controls. Our technicians also assist with system start-up along with some preparation and fabrication in our shop prior to installations or servicing. After our equipment has been installed (normally by a general contractor hired by the customer) we go to the site and verify installation, configure controllers and instruments, confirm automatic operation and start-up the systems. For the right individual, this job is challenging, fulfilling and rewarding. -About Filter Tech Systems: Filter Tech Systems has been in business for over 50 years providing equipment to produce drinking water for towns and communities. As such, we build skid-mounted equipment and package water plants that, once shipped out, need a person to go to the job site and ensure that they are installed correctly and working properly. We pride ourselves on our up-front customer support, quality equipment and follow-up field service. Filter Tech's core values include integrity, honesty, reliability, quality and hard work. We are team-oriented and value each person's contributions. We believe that our people are our competitive advantage; that it's our people that make this company a great one. Our team members all share a commitment to quality and customer service enabling them to focus on doing the job right and making sure that the customers' needs are always satisfied.