Chief Pharmacy Benefit Administrator
2 weeks ago
The Pharmacy Benefits Specialist II plays a pivotal role in managing pharmacy benefits for members. This involves overseeing PBM activities, serving as an expert on pharmacy benefits, and researching issues to resolve them.
This position requires experience in health plan operations, pharmacy, or PBM roles with a strong understanding of Medicare Part D, ODI, and NCQA regulations. The ideal candidate should also be proficient in using MS Word, Excel, and other software applications.
As a key member of the team, this individual will work closely with internal and external customers, providing timely and professional support.
- Monitors and oversees PBM activities, including daily monitoring of coverage determinations, denied claims, hospice, and end-stage renal disease (ESRD) claims.
- Provides expertise on pharmacy benefits and drug medical benefits.
- Attends meetings with internal and external customers regarding pharmacy matters and coordinates support activities related to the Pharmacy and Therapeutics (P&T) Committee and formulary maintenance.
- Implements regulatory changes in pharmacy, including Medicare, Ohio Department of Insurance (ODI), and NCQA guidelines.
- Resolves grievances, provides research, data, and member communications regarding Part D claims, including vendor oversight.
- Develops new pharmacy benefits with the PBM and coordinates delegated activities.
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Pharmacy Benefits Analyst
1 week ago
Cleveland, Queensland, Australia beBeeBenefits Full time US$93,000 - US$161,000Job DescriptionWe are seeking a highly skilled Pharmacy Benefits Specialist II to join our team.This role is responsible for monitoring Pharmacy Benefits Manager activities related to all lines of business, including Medicare Part D, Commercial and MarketPlace. The ideal candidate will serve as a Subject Matter Expert (SME) for all pharmacy benefit...
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Pharmacy Benefits Management Professional
6 hours ago
Cleveland, Queensland, Australia beBeePharmacyBenefits Full time US$23,422 - US$161,000Job Summary:The Pharmacy Benefits Specialist II role involves monitoring and providing oversight of Pharmacy Benefit Manager activities, including daily monitoring of coverage determinations, denied claims, hospice, and end-stage renal disease claims. As a Subject Matter Expert for pharmacy benefits, you will serve as a key resource for internal and external...
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Pharmacy Benefits Specialist II
1 week ago
Cleveland, Queensland, Australia Summa Health Full timeJoin to apply for the Pharmacy Benefits Specialist II role at Summa Health1 day ago Be among the first 25 applicantsJoin to apply for the Pharmacy Benefits Specialist II role at Summa HealthSummaCare E Market St, Akron, OHFull-Time / 40 Hours / DaysHybrid after trainingSummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a...
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Pharmacy Benefits Specialist II
18 hours ago
Cleveland, Queensland, Australia Summa Health Full timeJoin to apply for the Pharmacy Benefits Specialist II role at Summa Health1 day ago Be among the first 25 applicantsJoin to apply for the Pharmacy Benefits Specialist II role at Summa HealthSummaCare - 1200 E Market St, Akron, OHFull-Time / 40 Hours / DaysHybrid after trainingSummaCare is a Summa Health entity that offers health insurance in northern Ohio....
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Director of Pharmacy Operations
2 weeks ago
Cleveland, Queensland, Australia beBeeLeadership Full time $81,238 - $86,915Job OverviewThe Associate Director of Pharmacy is responsible for leading the administrative functions of the pharmacy department, including pharmacy programs and vendor management. This role requires a strong background in pharmacy administration and excellent leadership skills to manage cross-functional relationships across the organization.Key...
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Lead Pharmacist
7 days ago
Cleveland, Queensland, Australia beBeeLeadership Full time $66,000 - $99,000Job DescriptionWe are seeking a seasoned pharmacist to lead our pharmacy department in an administrative capacity.The ideal candidate will have extensive experience in pharmacy administration, preferably in a health plan or Pharmacy Benefit Manager (PBM) environment.Main Responsibilities:Liaise with cross-functional teams to develop and implement pharmacy...
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Chief Pharmacy Executive
5 days ago
Cleveland, Queensland, Australia beBeeLeadership Full time $48,000 - $72,000Leadership Opportunity in PharmacyThis role presents a unique chance to lead the pharmacy from inception, overseeing all operational aspects. As an expert Pharmacist Manager, you will be responsible for managing stock and staff, as well as supervising dispensing services, including vaccinations and clinical care.Key Responsibilities:Oversee overall store...
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Associate Dir, Pharmacy
2 weeks ago
Cleveland, Queensland, Australia Summa Health Full timeOverview Associate Dir, Pharmacy — Summa Health SummaCare - 1200 E Market St, Akron, OH. Full-Time / 40 Hours / Days. Hybrid after training. Responsibilities Leads the administrative functions of the pharmacy department; including but not limited to pharmacy programs, pharmacy vendors and manages cross-functional relationships across the...
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Associate Dir, Pharmacy
2 weeks ago
Cleveland, Queensland, Australia Summa Health Full timeOverviewAssociate Dir, Pharmacy — Summa HealthSummaCare E Market St, Akron, OH. Full-Time / 40 Hours / Days. Hybrid after training.ResponsibilitiesLeads the administrative functions of the pharmacy department; including but not limited to pharmacy programs, pharmacy vendors and manages cross-functional relationships across the organization. Facilitates...
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Payroll and Benefits Administrator
7 days ago
Cleveland, Queensland, Australia beBeeProfessional Full time $80,000 - $100,000Job OverviewA dedicated Payroll and Benefits Professional will ensure the accuracy and timeliness of payroll processing, administer employee benefits programs, and provide exceptional support to our staff.Key Responsibilities:Payroll AdministrationProcess weekly payroll in a timely and accurate mannerAudit and process payroll documentsManage employee time &...
