The Financial Analyst II supports the organization's FP&A, financial reporting, month-end close, budgeting, and forecasting processes. This role analyzes financial and operational data to produce reporting packages, dashboards, and financial models for leadership and internal stakeholders.
The Manager of Clinical Quality Monitoring and Oversight directs clinical monitoring activities, including retrospective case audits and delegation oversight, to ensure compliance with regulatory and accreditation standards. They manage a multidisciplinary team and serve as a second-level clinical authority, representing the department in cross-functional and client-facing meetings.
The Clinical Solutions Manager oversees the operational workflows for clinical products, including business analysis, implementation, and project management. They act as a subject matter expert and liaison between departments to ensure strategic initiatives meet corporate operational excellence and revenue goals.
The Counsel, Regulatory Compliance oversees regulatory activities, including monitoring state and federal laws and managing audits for various lines of business. This role serves as a strategic advisor to business leaders, ensuring organizational alignment with evolving legal requirements and compliance frameworks.
The Clinical Operations Pharmacist provides analytic and technical support to optimize clinical quality and cost-effectiveness of drug therapy for client plan sponsors. The role manages operational aspects of clinical programs and collaborates with stakeholders to identify performance improvement opportunities.
The Clinical Account Executive manages client relationships by implementing and optimizing clinical programs within PBM offerings. They provide expert clinical guidance, analyze performance data, and collaborate with internal teams to ensure client satisfaction and strategic alignment.
The Principal, Account Management provides strategic support to state clients and oversees the performance, compliance, and operational delivery of pharmacy benefit programs. This role manages account teams, fosters key business relationships, and identifies opportunities for growth and process improvement.
The Prior Authorization Coordinator will manage clinical authorization requests to ensure efficient pharmaceutical service delivery. They will work within a team to optimize healthcare outcomes and maintain high standards of service and quality.
The Business Systems Analyst V acts as a liaison between end-users and technical teams to analyze complex business needs and formulate system solutions. They are responsible for driving projects to completion, documenting requirements, and performing user acceptance testing to ensure software enhancements meet business objectives.
Assist in the development and maintenance of health plan documents, policies, procedures, and standard operating procedures. Perform quality checks on documents and process daily health plan ID card orders.
The Staff Accountant IV performs advanced accounting functions, including preparing financial reports, managing reconciliations, and overseeing month-end close processes. They also provide leadership by mentoring junior staff, driving process improvements, and acting as a liaison for international subsidiaries.
The Account Executive manages complex client relationships, overseeing business strategy, financial goals, and contract renewals. They lead client teams to ensure service excellence, operational efficiency, and sustainable growth within their assigned book of business.
The Principal, Business Intelligence Architect leads the design, implementation, and enhancement of BI solutions while serving as a subject matter expert for the Medicaid Fee-For-Service team. This role manages staff and collaborates with cross-functional stakeholders to translate complex business needs into scalable, high-quality data reporting solutions.
The Rebate Clinical Program Manager optimizes clinical quality and cost-effectiveness of drug rebates by managing medical drug utilization and performing claims analysis. They provide strategic recommendations to clients regarding billing integrity and ensure compliance with CMS dispute resolution processes.
Supervises a configuration team to ensure the accuracy, timeliness, and quality of client-specific benefit designs. Acts as an interdepartmental liaison and represents the configuration services department in project teams and client meetings.
The analyst performs in-depth testing and validation of pharmacy benefit configurations to ensure accuracy and adherence to business requirements. They also analyze claims adjudication results, document findings, and collaborate with internal and external stakeholders to resolve discrepancies.
The Appeals and Grievances Coordinator I manages the intake, processing, and notification of appeal and grievance requests while ensuring compliance with regulatory standards. The role involves performing outreach, maintaining accurate documentation, and collaborating with internal and external clients to resolve issues within established turnaround times.
The Appeals Clinical Specialist independently conducts clinical reviews of medical records and medication requests to make benefit coverage determinations. They ensure all appeal processes comply with regulatory, accreditation, and organizational standards while supporting cost-effective drug therapy.
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.
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 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 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 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 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.
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.
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.
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.
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.
