The Vice President of Pharmacy Services provides strategic leadership and oversight for all pharmacy operations, including PBM management, formulary strategy, and financial performance. They ensure regulatory compliance, optimize clinical and fiscal outcomes, and collaborate across the organization to support patient-centered care.
The Care Manager provides comprehensive, person-centered care management interventions to improve member health outcomes and reduce unnecessary healthcare utilization. They collaborate with physicians, hospitals, and community services to advocate for member-centered goals and ensure high-quality care coordination.
The Clinical Trainer designs, develops, and delivers comprehensive hybrid training programs for clinical and non-clinical staff within the Case Management department. This role also manages departmental documentation, standard operating procedures, and the internal SharePoint site to ensure regulatory compliance and operational efficiency.
The VP Medical Director manages Health Plan Medical Directors to provide clinical support for utilization, care, and quality management teams. They drive the development of evidence-based programs to manage medical expenses, quality outcomes, and utilization trends.
The Utilization Review Nurse ensures high-quality, cost-efficient medical outcomes for enrollees needing inpatient/outpatient authorizations. Responsibilities include reviewing prior authorization requests, coordinating transitions of care, and managing health care within compliance regulations.
