Process and finalize prior authorization requests in accordance with clinical protocols, client guidelines, and performance standards. Collaborate with internal teams, physicians, and pharmacies to resolve processing issues and ensure accurate, timely service delivery.
Supervises a configuration team to ensure the accuracy, timeliness, and quality of client-specific benefit designs. Acts as an interdepartmental liaison to drive operational execution and represents the configuration services department in project teams and client meetings.
The Staff Accountant III performs advanced accounting functions, including preparing financial reports, analyzing trends, and managing key accounting functions like cash and investments. They also drive process improvement initiatives, mentor less experienced staff, and ensure compliance with GAAP and Sarbanes-Oxley requirements.
The Principal, Formulary Consulting is responsible for developing and executing strategies to optimize rebate yields and reduce drug spend through formulary management and contract alignment. They serve as a subject matter expert for internal and external stakeholders, leading formulary strategy and managing complex rebate modeling.
Process and finalize prior authorization requests in accordance with clinical protocols and client guidelines. Collaborate with internal teams and external providers to resolve processing issues and ensure accurate, timely service delivery.
The Appeals & Grievances Coordinator II manages the intake, processing, and compliance of appeal and grievance requests according to regulatory standards. They also assist with quality reviews, staff training, and reporting while maintaining effective communication with internal and external clients.
The Clinical Account Executive manages client relationships by implementing and optimizing clinical programs within PBM offerings. They serve as the primary clinical point of contact, providing strategic guidance, data analysis, and reporting to ensure client satisfaction and goal alignment.
The Program Manager III is responsible for planning, creating requirements, and delivering updates for Medicaid and government-regulated programs. They coordinate multi-disciplinary teams and manage large-scale projects to ensure regulatory compliance and successful product implementation.
The specialist creates and maintains pharmacy prior authorization guidelines and medication request forms while providing technical support to clinical teams. They also manage the quality assurance process for medical exception guidelines and serve as a subject matter expert for internal and external stakeholders.
The Director of Underwriting provides detailed financial analysis and revenue estimates to support client acquisition and retention strategies. They also monitor profit and loss variances and ensure financial offerings align with corporate business objectives.
The Principal, Underwriting provides detailed financial analysis and revenue estimates to support client acquisition and retention strategies. They monitor market trends and profit/loss variances to ensure competitive pricing and alignment with corporate business objectives.
The Manager of Trade Emerging Markets coordinates market event activities across Trade Relations to ensure pricing impacts are accurately understood and operationalized. This role also supports the management of emerging market products by tracking milestones, facilitating cross-functional alignment, and documenting key decisions.
The Director of Rebate Economics leads the development and operation of strategic analytics, financial performance, and pricing strategies for rebate outcomes. This role partners with executive leadership and cross-functional teams to implement innovative pricing structures and optimize enterprise financial performance.
The Principal, Trade Initiatives oversees and manages key projects within the Trade Relations department, ensuring alignment with strategic goals and regulatory compliance. This role leads cross-functional teams to drive new product development, rebate operations, and continuous process improvement.
The Principal is responsible for developing and managing rebate analytics strategies to deliver enterprise-wide value and pricing transformations. They will lead cross-functional teams, manage client and vendor relationships, and ensure the accuracy and timeliness of financial reporting.
The Director is responsible for directing underwriting and economic strategy for complex trade and emerging market initiatives to support client value and EBITDA performance. This role leads cross-functional teams to develop financial models, evaluate program impacts, and ensure operational execution of pharmaceutical strategies.
The Prior Authorization Coordinator processes and finalizes prior authorization requests in accordance with clinical protocols and client guidelines. They also collaborate with internal teams and external providers to resolve processing issues and ensure accurate, timely service delivery.
The Clinical Account Executive II manages clinical projects and pharmacy coverage for state Medicaid agencies to optimize drug therapy quality and cost-effectiveness. The role also serves as a team lead, providing guidance to junior staff and coordinating clinical strategies to meet client service level agreements.
Provides strategic support to state clients and manages cross-functional teams to ensure compliance with agreement terms and program standards. Focuses on maintaining customer satisfaction, executing revenue growth, and overseeing operational delivery for Medicaid Fee-For-Service programs.
Plan, direct, and coordinate IT projects and programs related to Government Programs products and services to ensure goals are met on schedule and within budget. Lead multi-disciplinary teams through the full project lifecycle from vision and scope to implementation and closing.
Lead and manage all operational aspects of servicing and retaining clients while overseeing the transition of new business into the company. Ensure consistent customer satisfaction and the delivery of successful projects and additional revenue throughout the client life cycle.
Provides technical analyst support for claims testing processes during new plan and product implementations. Develops quality assurance strategies and validates business requirements to ensure accurate claims processing.
Manage the full-cycle recruitment process to source, attract, and hire exceptional talent across multiple business units. Partner with hiring leaders to define role requirements and build tailored sourcing strategies to reduce time-to-fill.
Responsible for the full lifecycle management of complex healthcare products, from strategic planning and requirements definition to delivery and enhancement. The role involves partnering with IT and business leadership to translate business strategies into actionable product roadmaps and measurable KPIs.
Lead and manage all operational aspects of servicing and retaining clients while managing the transition of new business into the company. Ensure consistent customer satisfaction and successful project delivery throughout the client life cycle.
Conduct independent clinical reviews of appeals by evaluating medical records and applying clinical criteria to determine benefit coverage. Ensure all reviews are completed accurately and timely in compliance with regulatory, accreditation, and organizational standards.
Lead all aspects of territory management to achieve sales targets by building relationships with brokers, consultants, and prospective clients. Work cross-functionally to manage RFPs, pricing, and onboarding to ensure successful client implementation.
Oversee the development and life-cycle management of a consumer digital solutions portfolio to enhance user experiences and business performance. Lead cross-functional teams to implement digital strategies, design user journeys, and manage product roadmaps from ideation to launch.
Manage a book of complex and strategic accounts to achieve financial goals and ensure high client satisfaction. Lead the account team in developing strategic plans, managing renewals, and overseeing client deliverables and growth opportunities.
Lead the enterprise network, payer, and underwriting strategies to drive financial growth and operational excellence across the PBM business. Oversee P&L performance, high-stakes contract negotiations, and the development of scalable governance frameworks for pharmacy networks.
Responsible for all drug rebate activities, including processing quarterly invoices and delivering financial reports. Manages dispute resolution with manufacturers and performs financial reconciliation with state programs.
