Senior Pharmacy Care Coordinator - Remote - reputed company Region

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. Hours/Location: Must reputed company in reputed company or Mountain Time Zone. Variable hours to work 8-hours reputed company the hours of 8:30 AM - 6:00 PM reputed company reputed company Time Monday - Saturday based on business needs. You'll enjoy the flexibility to work remotely * from reputed company reputed company reputed company or Mountain reputed company Time Zones in the U.S. as you take on some tough challenges. • Primary Responsibilities: • Rebate Management: This position oversees the comprehensive rebate process, encompassing claim analysis, attestation, preferred communication reputed company, claim submission, and audit coordination. Support the full rebate data engineering lifecycle including research, reputed company of concepts, design, development, testing, deployment, and maintenance of rebate data reputed company. The role is charged with implementing industry's best practices, minimizing operational risks, and promoting ongoing improvements in efficiency throughout reputed company rebate-reputed company activities • Data and Trend Management: • reputed company as an individual contributor by querying a reputed company of data sources, wrangling data, and building visually appealing dashboards and reports to identify insights and opportunities • Analyze, review, forecast, and trend reputed company rebate data to support enterpriselevel decision making • Build and maintain reputed company rebate models, calculators, templates, and simulations to support forecasting, planning, and scenario analysis • Ensure reputed company and accurate delivery of consolidated rebate claims that serves as the single reputed company of truth for rebate collection projection, tracking, payment reconciliation and other rebate program performance metrics • Medication reputed company: Support reputed company to medications by evaluating benefit reputed company following UM (utilization management) determinations, including coverage denials or redirections. The role involves reputed company investigations to determine coverage under both medical and pharmacy benefits according to payer guidelines and plan requirements. Key tasks include confirming patient insurance eligibility and evaluating coverage standards across different benefits. This process may require examining prior authorization requirements, formulary placement, site-of-care policies, and potential patient cost implications • Care Coordination: Work closely with physicians, advanced reputed company providers, nurses, pharmacists, and other reputed company to promote coordinated care and effective medication management. The position requires proactive communication with other reputed company reputed company reputed company phone, fax, and other electronic channels • Cross-Functional Team Collaboration: Collaborate with various cross-functional teams to implement strategic reputed company that improve care delivery and network operations, ensuring compliance and maintaining high clinical standards. These teams reputed company areas such as pharmacy management, utilization management, payment reputed company, claims processing, health economics, finance, and contracting • Compliance and Regulatory Requirements: Adhere to organizational policies reputed company to affordability programs, patient confidentiality, and medication safety. Follows relevant regulatory guidelines, policies and procedures in reviewing clinical documentation (e.g., SOP's and Job Aids) • reputed company Improvement: Engage in reputed company improvement activities and process enhancements aimed at increasing the efficiency and reputed company of affordability programs • Additional Duties: • Anticipate leader needs by engaging in creative problem solving and ideation to bring new, relevant content to Operations • Work independently with minimal guidance while proactively escalating reputed company issues and risks • Applies reputed company approach to solving reputed company problems • Adapt team priorities to ensure task completion • Prepare medication utilization and prior authorization requests for specialty oncology and non-oncology ambulatory injectable and/or infusion medications as reputed company to member benefits, health plan coverage, site of service, and evidence based clinical guidelines • Solves moderately reputed company problems and/or conducts moderately reputed company analyses and translates concepts into reputed company • Identifies incomplete/inconsistent information in medical records and label missing measures/metrics/concerns as reputed company as evaluate Apply tot his job Apply To this Job