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Department/Unit: Emergency Medicine General Work Shift: Per Diem (United States of America) Salary Range: $78,773.63 - $122,099.12 The clinical research coordinator is responsible for the organization and management of multiple industry sponsored and Investigator initiated clinical trials. The position is accountable for assisting in the timely and accurate conduct of research studies, being concerned primarily for the protection and care of the patient as a research patient from initiation to completion of study. Activities include participating in the study start up and termination procedures, working with study participants in various study tasks including patient recruitment, screening for eligibility, scheduling, physical assessments and biospecimen collection and processing, as well as data collection and study completion activities. The research coordinator serves as the liaison between PI and research site and the study sponsor and other vendors working on the trial. B. Pre-Study Initiation 1. Attend site pre-study visit/qualification visit meetings and Site Initiation Meeting, whether on site or remote, 2. Attend Investigator Meeting either remote or at location specified by the study sponsor (requires travel), 3. Complete and submit new protocol feasibility questionnaires with research site information., 4. Review confidentiality forms in conjunction with the ORA and obtain appropriate signatures f. IATA training certificates (if applicable for the study) 8. Complete the delegation of authority/duty logs to indicate the site personnel involved with the study and update as necessary throughout the course of the study with either new study personnel or personnel that is no longer involved with the study. 9. Prepare the patient informed consent (ICF) and assent (if applicable) by inserting the AMC required language into the sponsors ICF template and submitting to the sponsor for approval prior to IRB submission 10. Prepare for study site initiation visit a. Schedule visit and all required personnel (PI, sub-investigators, coordinators, research manager, pharmacy, clinical nursing units, operating room staff, etc.) to be present b. Schedule study specific training visits, c. Ensure all study required items are on-site (tablets for questionnaires, lab supplies, devices, study medication/investigational products, EKG machine, etc.) C. IRB 3. Prepare and submit annual continuing review reports and site termination report to the IRB of record, 5. Prepare and submit protocol deviations and/or violations to the study sponsor and IRB as necessary D. Patient Interactions 1. Participate in or conduct the informed consent process and HIPAA authorization, per AMC SOP, with research participants through discussion of the study protocol, procedures, timelines, risks, benefits and answering any questions. Obtain the appropriate signatures and dates/time on the ICF form and documents the process and file a copy in the patient’s medical record. Assures that patients sign any future amended versions of the consent if applicable. 2. Develop study schedule and required procedures, timelines, and deadlines with study patient and family, the PI and research team. 3. Coordinate patient follow-up study visits, treatments, testing, procedures, and schedules 4. Conduct patient study visits and required assessments per each individual protocol, 5. Assess patients for eligibility using the study specific inclusion and exclusion criteria., 7. Obtain required biological specimens from patient, i.e., urine, sputum, etc., 8. Perform blood draw to obtain blood specimens, 9. Administer study specific scales; i.e. stroke scales, mental assessments, etc., 11. Perform POC testing as applicable per SOP, i.e. urine pregnancy, urine drug test, blood sugar, urinalysis, 13. Dispense to patient and train patient on completion of study diary, if applicable, 14. Review completed patient diaries with patient, 16. Review oral study medication compliance with patient at each visit, 17. Collect required data from the patient Thank you for your interest in Albany Medical Center! Albany Medical is an equal opportunity employer. This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

General Responsibilities • Reviewing patient medication regimens and providing recommendations to optimize therapy based on clinical guidelines and best practices., • Conducting medication reconciliation to ensure accuracy and safety during transitions of care., • Educating patients and caregivers on proper medication use, side effects, and adherence strategies., • Collaborating with healthcare providers to develop and implement patient-specific care plans., • Monitoring patient outcomes and adjusting therapy as necessary to achieve therapeutic goals., • Participating in interdisciplinary rounds and providing pharmacotherapy recommendations., • Providing drug information to healthcare professionals and patients as needed., • Contributing to quality improvement initiatives related to medication use and patient safety., • Documenting interventions, clinical assessments, and recommendations in the electronic health record., • Staying current with developments in pharmacotherapy and evidence-based medicine., • Serve as a preceptor and mentor for pharmacists, pharmacy residents and students as needed Oncology • Conduct daily prospective review of treatment and therapy plans for infusion center(s), • Review all new therapy plan starts to facilitate drug therapy review and payer coverage, • Coordinate initiatives to assist with optimizing drug selection including biosimilar management and utilizing feedback from prior authorization team, • Assist prior authorization to locate references when needed to support off-label therapies, • Review/monitor inpatient and outpatient chemotherapy regimens, • Assist providers with clinical questions and treatment/therapy plan order entry, • Develops and reviews treatment/therapy plans, • Coordinate inpatient chemotherapy patients among provider, nursing and pharmacy staff and assist with transitions of care service for inpatient oncology unit, • Coordinate approval review of inpatient restricted medications with pharmacy management team, • Educate pharmacy and nursing staff on new oncological agents, protocols, and supportive care regimens as needed, • Counsel patients on new medications, chemotherapy regimens and provide discharge counseling, • Participate in quality, safety and other project work related to critical care, • Conduct medication use evaluations and research projects in collaboration with other healthcare professionals to identify areas of medication use optimization with publication and/or presentation at local and/or national meetings, • Graduation from an accredited School of Pharmacy with PharmD required, • Current active registration and licensure with the State of New Jersey Board of Pharmacy required, • Morristown Medical Center, Morristown, NJ, • Overlook Medical Center, Summit, NJ, • Newton Medical Center, Newton, NJ, • Chilton Medical Center, Pompton Plains, NJ, • Hackettstown Medical Center, Hackettstown, NJ, • Goryeb Children's Hospital, Morristown, NJ, • CentraState Healthcare System, Freehold, NJ, • Atlantic Home Care and Hospice, • Atlantic Mobile Health, • Atlantic Rehabilitation We also have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group. Atlantic Accountable Care Organization is one of the largest ACOs in the nation, and we are a member of AllSpire Health Partners. We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades: • 100 Best Companies to Work For ® and FORTUNE® magazine for 15 years, • Best Places to Work in Healthcare - Modern Healthcare, • 150 Top Places to work in Healthcare - Becker's Healthcare, • 100 Accountable Care Organizations to Know - Becker's Hospital Review, • Best Employers for Workers over 50 - AARP, • Gold-Level "Well Workplace": Wellness Council of America (WELCOA), • One of the 100 Best Workplaces for “Millennials” Great Place to Work® and FORTUNE® magazine, • One of the 20 Best Workplaces in Health Care: Great Place to Work® and FORTUNE® magazine, • Official Health Care Partner of the New York Jets, • NJ Sustainable Business Named one of America's 50 Best Hospitals by Healthgrades, a World’s Best Hospital by Newsweek and recognized as a Best Regional Hospital in the NY Metro area by U.S. News & World Report. Our Atlantic Neuroscience Institute is the region’s leader in neuroscience care. A hub for the New Jersey Stroke Network, we offer a broad range of advanced neurological, neurosurgical and neurodiagnostic services. We are also certified as a Level IV Epilepsy Center and home to the Gerald J. Glasser Brain Tumor Center, where more brain tumor surgeries are performed than anywhere else in New Jersey. Our CyberKnife® program is the largest and most experienced in the state. We also have a satellite emergency department in Union, NJ, which treats about 40,000 emergency cases each year. Committed to providing exceptional care, Overlook Medical Center has achieved the prestigious Magnet® recognition. This designation from the American Nurses Credentialing Center is the highest national honor for nursing excellence. What’s more, Overlook Medical Center has advanced certification from The Joint Commission for perinatal care and is designated an Advanced Comprehensive Stroke Center. Additional Joint Commission-certified services include behavioral health care, spine surgery, wound care, and primary care medical home (PCMH). Atlantic Health System offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted: Team Member Benefits • Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members), • Life & AD&D Insurance., • Short-Term and Long-Term Disability (with options to supplement), • 403(b) Retirement Plan: Employer match, additional non-elective contribution, • PTO & Paid Sick Leave, • Tuition Assistance, Advancement & Academic Advising, • Parental, Adoption, Surrogacy Leave, • Backup and On-Site Childcare, • Well-Being Rewards, • Employee Assistance Program (EAP), • Fertility Benefits, Healthy Pregnancy Program, • Flexible Spending & Commuter Accounts, • Pet, Home & Auto, Identity Theft and Legal Insurance Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer. EEO STATEMENT Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.

Aquestive Therapeutics is hiring for key positions across its commercial organization. About AquestiveTherapeutics With more than 20 years of pioneering patient-centered innovation, we've transformed how millions access life-saving medications. Our track record speaks for itself: 6 FDA approvals, 2.5 billion doses delivered worldwide, and a presence across 6 continents. As we prepare to launch Anaphylm™, our latest breakthrough in overcoming patient barriers, we're building a sales team that shares our commitment to innovation that matters. The Role As a Therapeutic Specialty Representative (TSR), you’ll be on the front lines of a critical product launch, introducing Anaphylm to healthcare providers. Anaphylm has the potential to be the first and only FDA-approved, non-invasive, orally delivered epinephrine product for the treatment of severe allergic reactions, including anaphylaxis. If approved, people at risk for severe allergic reactions would have a device-free, needle-free epinephrine option. Similar in size to a postage stamp, Anaphylm is administered as a thin, dissolvable film placed under the tongue. As a Therapeutic Specialty Representative (TSR), you will educate healthcare providers on how Anaphylm is designed to address barriers that prevent patients from carrying and administering epinephrine, building trusted relationships to drive adoption of Anaphylm. This role is ideal for ambitious sales professionals who thrive in a launch environment and who want their work to have genuine clinical impact. Key Responsibilities Strategic Territory Development • Design and execute territory business plans that identify high-potential accounts and drive measurable market penetration, • Analyze prescribing patterns, payer landscapes, and competitive dynamics to prioritize efforts and maximize ROI, • Partner with Regional Sales Managers to align field execution with broader commercial strategy Clinical Education and Relationship Building • Deliver compelling, compliant clinical presentations that demonstrate Anaphylm's value in addressing unmet patient need, • Build trust-based relationships with key prescribers, practice administrators, and healthcare stakeholders through consistent engagement and authentic dialogue, • Navigate complex clinical objections with insight and empathy, positioning Anaphylm as the solution to real-world challenges Access and Pull-Through Excellence • Master payer coverage dynamics across your territory—national, regional, and local insurance landscapes, • Collaborate with Market Access, to overcome prior authorization barriers and ensure seamless patient onboarding, • Drive formulary wins and in-office pull-through by equipping providers with the tools and knowledge they need Flawless Execution • Orchestrate high-impact customer engagement programs including lunch-and-learns and speaker events, • Maintain CRM excellence: capture detailed call notes, payer feedback, sampling activity, and strategic next steps with precision, • Ensure 100% compliance with PDMA sampling requirements, AE/product complaint reporting, and promotional guidelines Field Intelligence * Serve as the eyes and ears of the organization, sharing customer insights, competitive intelligence, and best practices that inform strategy Contribute to a culture of continuous learning and improvement across the sales organization Qualifications Required • Bachelor's degree, • 3+ years of pharmaceutical, specialty, or B2B sales success with proven track record of exceeding targets, • Deep understanding of payer coverage, prior authorization workflows, and access barrier navigation, • Strong analytical skills with demonstrated ability to translate data into actionable territory strategies, • Willingness to travel overnight 50% for customer meetings, conferences, and sales meetings Preferred • Launch experience in specialty or allergy markets., • Specialty pharmacy or hub services background, • Mission-driven achievers motivated by outcomes results-oriented with passion for improving patient outcomes, • Strategic hunters who combine creativity, persistence, and disciplined execution to drive market growth, • Resilient and adaptable performers able to navigate obstacles, adapt quickly, and thrive in a competitive, fast-paced launch environment, • Collaborative team players who elevate others while maintaining accountability for outcomes, • Ensure field compliance with all company and industry standards, including:, • Sampling and PDMA (if applicable), • Adverse Event (AE) and product complaint reporting, • On-label and compliant promotional dialogue, • CRM data quality and timely documentation, • Maintain alignment with corporate policies, training, and legal/regulatory requirements. The Company is required to provide a reasonable estimate of the salary range for this job in certain states and cities within the United States. Final determinations with respect to salary will take into account a number of factors, which may include, but not be limited to the primary work location and the chosen candidate’s relevant skills, experience, and education. Expected salary range: $125,000 - $150,000/per year. Available benefits include bonus eligibility, health care and other insurance benefits (for employee and family), retirement benefits, paid holidays, vacation, and sick days The above statements are intended to describe the general nature and level of the work being performed by colleagues assigned to this position. This is not intended as an exhaustive list of all responsibilities, duties, and skills required. Aquestive reserves the right to make changes to the job description whenever necessary. As part of Aquestive’s employment process, final candidate will be required to complete a drug test and background check prior to employment commencing. Aquestive provides equal employment opportunities to all colleagues and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Description The Services Management Coordinator plays a crucial role in the delivery of healthcare services for patients within the assigned area. The Services Management Coordinator serve as liaison for patient care activities in specific program and ensures coordination of care around the course of the patient visit as well as subsequent patient interactions between visits. The Services Management Coordinator is responsible for multiple components of care coordination within the program(s). Specifically, Services Management Coordinators are responsible for providing administrative assistance to our providers, nurses, medical directors, medical review and case management team. Responsibilities • Plays a lead role in the navigation of care and ensures that patients understand their overall program benefits as well as what they can expect the program to provide. This may include but is not limited to: liaison with Physicians, Patients education, • Sets goals with patient and care team to coordinate care, documents goal in program dashboard/calendar tool. Follow ups to be tracked include visit status reminders, scheduled follow up and specialty appointments, authorization submitted for review., • Ensures that all orders placed by the providers (internal and external) are authorized after confirming the service falls under the patients covered services., • Services as the primary point of contact to education patients pharmacy benefits, and assist with obtaining prior authorizations when applicable. This may include: Submitting refill request/confirm patients preferred pharmacies; verify coverage., • Organizes correspondence and future program plans for the patient based on program interactions in the electronic medical record as well as in the program benefits systems. This involves ensuring that a plan is made with next steps in the process., • Offers extensive patient navigation between program visits and other encounters. This includes detailed discussion with the patient to review next steps and resources, facilitation of patient concerns review, questions or concerns related to coverage.., • Educates and communicates closely with the patients to ensure they have a full understanding of the benefits offered by the program. Patient education provided on all relevant program benefits., • Provides recommendations for process improvement and services improvement aimed at improving patient experience, and participates in ongoing pilot programs to improve patient engagement., • Additional duties as assigned Qualifications • 3 years’ experience in healthcare/customer service or relevant experience., • Bachelor’s degree or equivalent experience Employer Description Strength through Unity and Inclusion The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history. About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization. Compensation The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $64526.72 - $70000 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

Korn Ferry has partnered with our client on their search for the role, Medical Director - Medical Management. The Opportunity The Medical Director will be responsible for assuring appropriate and optimized health care delivery for members. This position is primarily responsible for conducting medical necessity reviews, including prior authorizations, concurrent reviews, retrospective reviews, and appeals determinations. This role will focus on efforts to achieve excellence in healthcare cost management, quality, member experience, and improved population and member outcomes. They will serve as a clinical expert for teams dedicated to concurrent review, prior authorization, case management and strategic program development and implementation. The Medical Director will serve as a resource for our IPA physicians. The Medical Director will apply evidence-based guidelines to decision making, collaborate with other senior leaders in efforts that enhance the quality-of-care delivery, improve outcomes, and improve value delivered to our key stakeholders. Key Responsibilities • Support pre-admission review, utilization management, concurrent and retrospective review process and case management. Areas of responsibility may include Medical, Behavioral and Pharmaceutical services, • Provide professional leadership and direction in the utilization/cost management (UM) and clinical quality improvement (QI), as measured by benchmarked UM and QI goals., • Work collaboratively as a clinical resource to other plan functions that interface with medical management such as provider relations, provider services, claims management, Business Intelligence, etc., • Ensure members receive safe, effective, equitable, efficient, timely and patient-centered health care services within their health plan benefits., • Carry out medical policies consistent with NCQA and other regulatory bodies., • Participate and/or chair clinical committees and work groups as assigned., • Review medical care, medical service, and pharmacy requests against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements., • Identify potentially unnecessary services and care delivery settings, and recommend alternatives, as appropriate., • Review appeals of medical and pharmacy denials against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements., • Participate in an after-hours telephonic on-call rotation to provide clinical guidance and support for urgent matters outside regular business hours., • Identify opportunities for corrective action plans to address issues and improve organizational performance., • Collaborate with Provider Networks, Quality and Medical Management teams in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes., • Participate in the retrospective review and analysis of performance from summary data of paid claims, encounters, authorization logs, compliant and grievance logs, and other sources., • Provide periodic written and verbal reports and updates as required in the utilization, • Management, Case Management and Quality Management Program descriptions., • Assure conformance with legal and regulatory requirements; support NCQA qualification activities, including site visits and response to accrediting and regulatory agency feedback., • Participate in risk management, claims administration, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, credentialing, provider orientation and profiling, etc., • Conduct quality improvement and outcomes studies as directed by the state and federal regulatory agencies, and internal operating committees, • Support the grievance process ensuring a fair outcome for all members., • Monitor member and provider satisfaction survey results and implement changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants., • May be asked to chair various committees, such as UM, CM, Peer Review and Credentialing., • Promote wellness and ensure programs of prevention, education and outreach to members and providers consistent with the company’s Mission, Vision and Values., • Perform and oversee in-service staff training and education of professional staff., • Contribute to the development of strategic planning for existing and expanding business; recommend changes in program content in concurrence with changing markets and technologies., • Participate in key marketing activities and presentations, as necessary, to assist the marketing effort., • Perform other duties as assigned to support departmental and organizational goals. The Candidate Qualification Requirements: Skills, Knowledge, Abilities • Familiarity with NCQA, CMS, state Medicaid, and other regulatory guidelines., • Strong analytical, organizational, and clinical decision-making skills., • Excellent communication skills (written and verbal) for peer-to-peer interactions and interdisciplinary collaboration., • Proficiency with utilization management tools and platforms (e.g., InterQual, MCG, care management systems)., • Demonstrated ability to work effectively across teams and departments to support organizational goals., • Understanding of value-based care models and population health strategies Education • MD or DO degree required., • Board certification required (ABMS or AOA recognized specialty)., • Active, unrestricted license to practice medicine in the state(s) of operation (e.g., New York)., • No history of sanctions from state licensing boards or federal healthcare programs (e.g., Medicare, Medicaid) Experience • Minimum of 5 years of clinical practice experience., • Minimum of 2 years of experience in a managed care environment or utilization management role strongly preferred., • Experience with reviewing medical necessity, interpreting clinical guidelines, and participating in appeal and grievance processes is highly desirable. The Company The Company is the largest physician-owned and led IPA in the Northeast, serving the five boroughs, Long Island, and Westchester. Their network includes more than 8,000 primary care and specialist physicians delivering services to over 200,000 members under capitated or shared risk arrangements, including patients enrolled in Commercial, Medicare, and Medicaid products. The company has meaningful long-term partnerships with Emblem Health as well as other major health plans in the New York metro region. The Management Services Organization employs over 180 staff members dedicated to ensuring practices can deliver great care to their patients while effectively utilizing healthcare resources.

Our Client, a Retail Pharmacy company, is looking for a Prior Authorization Pharmacy Tech I for their Remote location. Pharmacy Technician license with no restrictions, must be active Advanced computer skills including word processing and spreadsheet utilization. The Tech I Prior Auth takes in-bound

Job DescriptionJob Overview As a Patient Liaison for a specialty pharmacy, you will serve as a key connection between the pharmacy, healthcare providers, and patients. Your primary responsibility will be to facilitate the timely processing, approval, and ensuring dispensing of prescribed medications. This role requires a blend of clinical knowledge, communication skills, and organizational and sales acumen. You will support patients referred from medical offices by assisting with prescription clarifications, benefits coordination, and addressing medication access issues. Additionally, you will cultivate strong relationships with prescribers and insurance providers to ensure seamless care and optimal outcomes for patients. You will act as a relationship manager for medical providers and their offices. You will proactively build and maintain trusted partnerships, encouraging them to refer new patients and strengthening ongoing collaboration to ensure positive outcomes for all parties. Responsibilities • Serve as a liaison between specialty pharmacies, prescribers, and insurance providers to ensure seamless access to prescribed medications and clarify any prescription-related needs., • Monitor market trends and competitor activity to adjust strategies, identify potential growth areas, and implement best practices for marketing and patient access., • Focus on sales/marketing efforts to promote the pharmacys services and secure referrals from providers, contributing to growth in patient enrollment and medication access., • Utilize sales strategies to target and expand market presence, identify new opportunities, and increase awareness of the pharmacys offerings among key stakeholders in the healthcare ecosystem., • Provide exceptional customer service, ensuring that both internal and external customers (patients, providers, pharmacy staff) receive timely and accurate support., • Maintain frequent communication with patients, providers, and pharmacies, clarifying prescription orders and resolving any issues., • Coordinate efforts with providers and specialty pharmacies to improve patient turnaround times and ensure optimal medication access., • Manage and prioritize multiple initiatives, resolving complex cases independently and efficiently, while maintaining a focus on customer satisfaction and outcomes., • Leverage marketing tactics, including digital communication, educational resources, and outreach, to effectively promote the pharmacys services and increase patient engagement.Requirements, • Preferred experience in a health care setting, preferably within a specialty pharmacy environment., • Strong understanding of medication administration processes and patient care standards., • Familiarity with medical terminology related to pharmacy practices, medications and prior authorization process., • Previous experience as a pharmacy technician is highly desirable., • Excellent communication skills with the ability to build rapport with healthcare professionals and patients alike., • Ability to work independently and as part of a collaborative team focused on enhancing patient service., • Commitment to ongoing professional development in the field of specialty pharmacy.Qualifications:, • High School Diploma or GED required, • Associate or bachelors degree preferred, • 1+ years of pharmacy/medical work experience or related field, • Strong customer service, communication, and sales skills, • Proven ability to manage multiple accounts and projects independently, • Understanding of product and payer reimbursement landscapes, • Ability to work collaboratively with a variety of stakeholders, including medical offices, pharmacies, and insurance companies, • Valid drivers license required, • Must be willing and able to drive from office to office within the assigned area (TBD)Preferred Skills:, • Previous experience in sales, marketing, or customer relationship management within the healthcare industry, • Full Time, • On-siteSchedule:, • Monday to Friday, • 40 Hours weeklyPay Rate:, • Bi-weekly, • $22-30 hourly (based on experience)Benefits:, • Paid time Off, • Medical Insurance, • 401k (Matching), • Travel Stipend, • Bonus based on PerformanceLocation: Paterson NJ

Job Description Job description Looking for a bilingual ( English & Spanish) individual who is: Motivated - Reliable - Able to multitask - High sense of Self-awareness A great communicator with the ability to build strong relationships. Prior knowledge of retail & specialty pharmacy is a plus. Along with experience with Prime Rx pharmacy software (MMS) and prior authorization assistance. Send resume to: Company DescriptionRetail Pharmacy looking for bilingual Cashier / Pharmacy TechRetail Pharmacy looking for bilingual Cashier / Pharmacy Tech

Job Description Apicha Community Health Center aims to improve community health by providing access to comprehensive primary care, preventive health services, mental health, and supportive services. The center is dedicated to delivering high-quality services that enhance the quality of life. It also advocates for and offers a welcoming environment for underserved and vulnerable populations. Position Summary: We’re looking for a compassionate, respectful professional full-time professional Healthcare Case Manager for our Jackson Heights location. The successful candidate will ensure the quality care of the Apicha CHC’s patients by promoting quality, and cost-effective outcomes. Provide case management services to children, families, and adults to ensure the services they receive are appropriate for their specific needs. A Healthcare Case Manager also works with the patient’s support systems to make sure care arrangements are in line with the needs of the patients with the input of the Care Team from multidiscipline. Job Responsibilities: • Client Services and Direct Care – provide proactive primary case management to Apicha’s Primary Care Clinic including intake, comprehensive assessment/reassessment, and individualized care plan development to ensure access to medical care and other services including communication with Apicha multidisciplinary care learn at regular intervals to ensure patients have positive health outcomes., • Work closely with the multidisciplinary care team, patient’s families/social support, and other services providers with interdisciplinary approaches at regular intervals to ensure patients have positive health outcomes conducting monitoring and evaluation of progress., • Engage patients and families in developing positive, trusting relationships to healthcare., • Help to manage emotional distress on the part of the patient or their family in resolving crisis situation. Use discretion and judgment when determining an appropriate course of action., • Build and maintain professional relationship with patients, as well as business type relationship with outside service providers., • Manage conflict, promote change and growth, and facilitate self-management of all patients., • Provides clinic-based health education in conjunction with regularly schedules primary care visits., • Obtain prior authorization for pharmacy and/or medical services as required by patient’s health insurance plan., • Represent Apicha CHC to promote services and recruit patients specifically individual with low income and/or community of color including participate in events, • Collaboration and Services – use strong collaborative abilities to put together plans for patient care by working with patients and their families to discover their specific needs and coordinating with outside companies to ensure proper care., • Identify, coordinate and link patients with additional services, e.g. specialty care, entitlements, mental health and substance use treatment, comprehensive case management, community follow-up case management, AIDS Drug Assistance Program (ADAP), as needed and report outcome to the multidisciplinary care team including timely follow-up., • Response to telephone, e-mail, referral inquiries of services available at the Agency and other requests for information in timely manner., • Work as a part of multidisciplinary care team and for continuous quality improvement (CQI) activities as a part of Department of Support Services., • Communicates in a timely manner with the multidisciplinary care team (medical providers, therapist, patient’s legal guardian, psychiatrist, pediatrician, and other specialty case manager) about missed or rescheduled appointments and any special assistance required, i.e. interpreter, transportation, and/or cultural to ensure continuity of care., • Participates internal and external meetings/trainings including assists as requested and appropriate., • Compliance – maintains patient’s records in an updated (real-time), organized, and legible condition including completes and submits pertinent forms, reports, and summaries in a timely manner., • Maintain accurate records of services rendered., • Maintain accurate reporting in both electronic and paper record to ensure and meet all documentation and data reporting requirements of the center., • Adheres to Apicha CHC policy and procedure as required that inclusive of NYC, NYS, and Federal requirements, as well as Apicha’ s Department of Support Services. Qualifications: • Bachelor’s degree in related field (i.e., health, nursing, mental health, child and family studies, public health, or other human services fields) with 2 years of qualifying experience required. May consider bachelor’s degree in non-related field with 4 years of relevant work experience., • Experience working with target populations strongly preferred. The target populations: including but not limited to: children and family, individuals with Serious Mental Illness, developmental disabilities, serious substance use disorders (SUDs), Individuals with high risk of or living with HIV/AIDS, chronic hepatitis, and other individuals with social needs., • Fluency in Spanish or one of Asian languages preferred., • Excellent written and verbal communication skills in English required., • Ability to work effectively in both a collaborative as well as individual setting, • Ability to use and adapt to various applications (Outlook, Word, Excel, PowerPoint, eCW, eICARE, AZARA, HCS, MAPP, Healthix, PSYCKES, etc.) required., • Excellent customer service skills to assist in resolving patients and/or providers concerns., • Ability to work flexible hours including some evenings and weekends required., • Ability to multitask and manage multiple projects in a stressful environment is strongly recommended. At Apicha, we believe that serving the needs of our staff is just as important as serving the needs of underserved people of New York City as such we are proud to offer our team members a competitive employee benefits package which include 11 Paid Holidays, vacation and sick leave, Health Insurance Coverage, Flexible Spending Account, Life Insurance, Employee Assistant Program just to name a few.

Job Description Overview Amerita, Inc. is a leading provider in home Infusion therapy. We are looking for an Intake Coordinator to join our Intake team as we grow to be one of the top home infusion providers in the country. The Intake Coordinator will report to the General Manager and work in our location branch. Amerita is an entrepreneurial-founded company and a wholly owned subsidiary of PharMerica. The home infusion market is positioned for rapid growth driven by the aging population, increase in chronic diseases, robust pipeline of infusible drugs coming to market, and an industry shift from hospital delivery settings to lower-cost, high-quality alternative providers such as Amerita. As a core member of the Intake team, you will have primary responsiblity for the timely clearance of new referrals. We will help you achieve your goals through continuous professional development and regular career progression discussions. Amerita’s intake coordinator are responsible for working in coordination with the sales and pharmacy teams process patient referrals and admissions in a timely manner. Intake coordinators must gather necessary patient information to create patient records and working with access operations to communicate insurance coverage to patients and referral sources. The Intake coordinators are often the first point of contact for patients and referrals sources and must create and maintain a positive, calm and supportive atmosphere; emphasizing personal interest and compassion for our patients. Schedule: Monday - Friday 8:30am - 5:00pm • Competitive Pay, • Health, Dental, Vision & Life Insurance, • Company-Paid Short & Long-Term Disability, • Flexible Schedules & Paid Time Off, • Tuition Reimbursement, • Employee Discount Program & DailyPay, • 401k, • Pet Insurance Responsibilities • Responsible for processing referrals received from referral sources., • Ensures that all required documentation has been received to process the referral timely, • Ensures Intake referral checklists are complete, • Enters patient demographic, clinical, and insurance and authorization information into the computer system, • Coordinates with other departments including Sales, Access and clinical staff regarding the status of the referrals and any authorization requirements and out of pocket cost required to be collected before delivery, • Ensures that insurance verification is completed and patient has accepted financial responsibility prior to initial shipment., • Completes documentation of progress notes in computer system, • Notifies patients/caregivers regarding insurance coverage and payment responsibilities, • Maintains confidentiality of patient and proprietary information., • Other duties as assigned Supervisory Responsibility: No Qualifications • High School Diploma/GED or equivalent required; Associate’s Degree or some college preferred, • Experience working with all payer types, including Medicare, Medicaid and commercial insurance companies, • Knowledge of insurance verification and pre-certification procedures, • Understands the scope of services that Amerita can provide

Job DescriptionJob Summary We are seeking an experienced Pharmacist In Charge (PIC) to join our team at J&J Pharmacy! As a pharmacist in charge, you will be receiving incoming prescriptions, reviewing them for accuracy, and filling them with the correct medicine and dose. You will also be talking with customers to help them understand their medications and possible side effects, advising them on medication storage, and maintaining a safe, clean work environment. The ideal Pharmacist candidate is comfortable working in a fast-paced environment, has excellent communication and interpersonal skills, and is familiar with pharmaceutical best practices. Responsibilities • Dispensing prescriptions, compounding, and selling pharmaceuticals, medicines and related drug items, on behalf of the Company., • Keep in proper form all records required relating to the purchase and dispensing of all prescription required drugs including controlled substance requirements., • Medication management and ensuring appropriate handling and safety., • Eliminate from stock all misbranded and adulterated drugs including outdated drugs and drugs mot properly labeled., • Provide for the proper storage of drugs in order to prevent loss or deterioration., • Insure coverage of the pharmacy by licensed pharmacists., • Insure against unauthorized refills of prescriptions and unauthorized sale of legend drugs., • Insure against unauthorized entry into the pharmacys dispensing and compounding area and ensure appropriate security., • Patient support and education, maintain accurate patient records and documentation., • Any and all tasks by a licensed professional in this field., • Maintain license status and continuing education credentials for professional license., • Ensure that no prescription required drugs or devices are sold at wholesale unless the pharmacy possesses a New York State Board of Pharmacy wholesaler registration., • Be certain that the pharmacy is properly registered and operating in accordance with the present laws, rules and regulations., • Issue verbal and written notices to employees and subordinates concerning the laws, rules and regulations (Federal, state and local) relative to proper pharmacy practice., • Additionally, the pharmacist is responsible for all day-to-day functions associated with the operation, maintaining staffing, safety and maintenance of the pharmacy including dealing with the mandatory local, state, and federal regulations regarding the pharmacy., • Must hold a current state pharmacist license or degree, • Strong customer service skills, • Excellent attention to detail, • The ability to multitask and shift priorities, as needed, • A Pharm.D. (Doctor of Pharmacy) with immunization certification, preferred, • Prior Authorization experience, preferred, • Reliable transportation to on-site locationSchedule, • Monday-Friday, • Alternating Saturdays, • Full Time, • 50 hoursLocation: Teaneck, NJ Pay Rate • Bi Weekly, • $55-60 hourly based on experienceBenefits, • Paid time off, • 401k, • Health Insurance, • Vision, • Dental, • Training and Development, • Bonus Based on Performance

Job Description Overview Amerita, Inc. is a leading provider in home Infusion therapy. We are looking for an Prior Authorization Specialist to join our team as we grow to be one of the top home infusion providers in the country. This role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process. Amerita is an entrepreneurial-founded company and a wholly owned subsidiary of PharMerica. The home infusion market is positioned for rapid growth driven by the aging population, increase in chronic diseases, robust pipeline of infusible drugs coming to market, and an industry shift from hospital delivery settings to lower-cost, high-quality alternative providers such as Amerita. Schedule: (Remote) Monday - Friday 8:30am - 5:00pm • Competitive Pay, • Health, Dental, Vision & Life Insurance, • Company-Paid Short & Long-Term Disability, • Flexible Schedules & Paid Time Off, • Tuition Reimbursement, • Employee Discount Program & DailyPay, • 401k, • Pet Insurance Responsibilities • Initiate, process, and oversee the clinical review of prior authorization requests for medication and supply, ensuring compliance with payer requirements and clinical guidelines., • Collaborate with healthcare providers, insurance companies, and patients to gather necessary clinical information and documentation to support prior authorization submissions., • Submit prior authorization requests accurately and in a timely manner, utilizing electronic submission platforms and following established protocols., • Knowledgeable to perform all PA functions. Qualifications • High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy, • 1+ years pharmacy experience, • Pharmacy or healthcare-related knowledge, • Knowledge of pharmacy terminology including sig codes, and Roman numbers, brand/generic names of medication, • Basic math and analytical skills, • Intermediate typing/keyboard skills

Job DescriptionJob Summary: We are seeking an experienced Pharmacist to join our team at Downtown Pharmacy! As a Pharmacist, you will be receiving incoming prescriptions, reviewing them for accuracy, and filling them with the correct medicine and dose. You will also be talking with customers to help them understand their medications and possible side effects, advising them on medication storage, and maintaining a safe, clean work environment. The ideal Pharmacist candidate is comfortable working in a fast-paced environment, has excellent communication and interpersonal skills, and is familiar with pharmaceutical best practices. Responsibilities • Read and review incoming prescriptions for accuracy, suitability to patient, and potential interactions, • Provide information to patients on side effects, dosage, specific storage needs, and interactions with other medications, • Maintain excellent patient records and pharmacy files, • Conduct regular inventory and maintain proper standards for accepting new inventory and categorizing it appropriately, • Maintain a clean, safe work environmentQualifications, • Must hold a current state pharmacist license (RPh), • MUST have Immunization License, • Prior Authorization experience, • Compounding experience Preferred, • Strong customer service skills, • Excellent attention to detail, • The ability to multitask and shift priorities, as needed, • Reliable transportation to and from workLanguages, • English, • Chinese (not required but a plus), • Russian (not required but a plus), • Spanish (not required but a plus)Benefits/Perks, • Employee Discount, • Performance based Bonuses, • Training & Development, • Employee parkingSchedule, • Part Time, • 14-18 hours weekly, • Monday-Friday, • Saturdays & Sundays (as needed), • Flexible SchedulePay Rate, • $55-$70 per hour, • Biweekly pay period

Job DescriptionJob Summary: We are seeking an experienced Staff Pharmacist to join our team at Downtown Pharmacy! As a Staff Pharmacist, you will be receiving incoming prescriptions, reviewing them for accuracy, and filling them with the correct medicine and dose. You will also be talking with customers to help them understand their medications and possible side effects, advising them on medication storage, and maintaining a safe, clean work environment. The ideal Pharmacist candidate is comfortable working in a fast-paced environment, has excellent communication and interpersonal skills, and is familiar with pharmaceutical best practices. Responsibilities • Read, review and dispense incoming prescriptions for accuracy, suitability to patient, and potential interactions, • Provide information to patients on side effects, dosage, specific storage needs, and interactions with other medications, • Maintain excellent patient records and pharmacy files, • Conduct regular inventory and maintain proper standards for accepting new inventory and categorizing it appropriately, • Maintain a clean, safe work environment, • Accurately dispense prescription medications., • Review prescriptions for legality and clinical appropriateness., • Check for drug interactions, contraindications, and allergies., • Counsel patients on medication usage and side effects., • Promote medication adherence., • Administer immunizations (e.g., flu, COVID-19, shingles)., • Comply with NY State and federal pharmacy laws., • Maintain accurate patient and prescription records., • Manage controlled substances per DEA and NYS guidelines., • Oversee pharmacy technicians and interns., • Perform medication therapy management (MTM)., • Handle insurance claims and resolve coverage issues., • Monitor for prescription fraud and drug misuse., • Participate in public health initiatives (e.g., health screenings)., • Stay updated on new drugs, therapies, and regulationsQualifications, • Must hold a current state pharmacist license (RPh), • MUST have Immunization License, • Prior Authorization experience required, • Compounding experience preferred, • Reliable transportation to and from work location, • Strong customer service skills, • Excellent attention to detail, • The ability to multitask and shift priorities, as neededLanguage Preference, • English, • Chinese (not required but a plus), • Russian (not required but a plus), • Spanish (not required but a plus)Benefits/Perks, • Paid Time Off, • 401k (Matching), • Medical Insurance, • Dental Insurance, • Vision Insurance, • Employee Discount, • Performance based Bonuses, • Training & Development, • Free Uniforms, food and snacksSchedule, • Full Time, • 30-40 hours weekly, • Monday-Friday, • Saturdays & Sundays (as needed), • Flexible SchedulePay Rate, • $55-$70 per hour, • Biweekly pay periodLocation: Lower Manhattan

Job Description Hi, we're Oscar. We're hiring a Senior Manager, Medical Economics to join our Medical Economics. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The Senior Manager, Medical Economics, leads a team of analysts to guide next steps to support Oscar's total cost of care (TCoC) strategy and efforts. The Senior Manager collaborates with analytical leads across forecasting, medical economics, pricing, network analytics, and data science units to identify medical expense saving opportunities and to develop sound projections and measurements of the medical cost effects and clinical outcomes of programs, with an ultimate goal of improving total cost of care and driving affordability value. You will partner with Oscar's Office of Clinical Affairs and data science team to ensure accurate projections of clinical policy initiatives are reflected in management reporting — e.g. financial close, forecasts, program performance monitoring. You will report into the Senior Director, Medical Cost Analytics. Work Location: This position is based in our NYC office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid Pay Transparency: The base pay for this role is: $158,400 - $207,900 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Lead team programs to identify and measure cost-saving programs., • Provide mentorship, and development planning for team members to promote growth and learning., • Maintain current knowledge of medical economics best practices, and drive innovation and new approaches., • Develop proactive financial models to assess the potential cost and use impacts of proposed clinical programs, network strategies, and policy changes. Conduct sensitivity analyses and stress-testing on models to understand the range of potential outcomes under multiple utilization and cost scenarios., • Perform in-depth analysis of integrated claims and operational data — e.g. medical, pharmacy, labs, authorizations) to identify cost and trend drivers., • Design and build retrospective studies to measure the actual financial and clinical outcomes of implemented programs, comparing results against initial projections., • Promote and shape best practices with respect to documentation., • Contribute departmental improvements in automation, AI application, and analytic tooling to increase efficiency and the sophistication of your team's work., • Serve a trusted analytic partner and advisor to team members in supported functional units., • Maintain relationships and lines of communication with stakeholders., • Influence and collaborate with stakeholders to guide strategic business decisions with respect to medical expense initiatives., • Compliance with all applicable laws and regulations, • Bachelor's degree in a STEM field., • 7+ years of relevant quantitative analysis experience., • Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one., • Significant experience analyzing and forecasting the financial impact of proposed changes to clinical policies, policy sets, utilization management processes, and clinical pathways., • Experience developing measurement of clinical intervention ROI., • Knowledge of prior authorization optimization and automation., • Familiarity with pharmacy economics., • Background in value-based care analytics. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Notice to Job Applicants.

Job DescriptionCompany: Link Rx: Location: Central New Jersey (preferred) | Territory: New Jersey & New York About LinkRx LinkRx is a healthcare solutions company dedicated to improving patient access to innovative therapies. We partner with biopharmaceutical manufacturers and provider networks to streamline reimbursement processes, optimize patient outcomes, and support successful product launches. We are currently seeking a Field Reimbursement Manager (FRM) to support the launch of a new treatment for major depressive disorder (MDD) scheduled for Q1 2026. This individual will play a pivotal role in ensuring providers and patients across New Jersey and New York receive comprehensive reimbursement support. Position Summary The Field Reimbursement Manager will serve as the primary point of contact for providers on reimbursement matters related to the new MDD therapy. The role requires strong account management skills, the ability to navigate payer and specialty medication access challenges, and leadership experience to drive initiatives across the territory. Key Responsibilities • Coordinate reimbursement support efforts across assigned provider networks in NJ and NY., • Partner with provider offices to resolve access barriers, including benefit verification, prior authorization, and claims support., • Deliver education and training to office staff on reimbursement processes and resources., • Maintain strong relationships with prescribers, practice managers, and support staff to facilitate timely patient access., • Provide regular field insights and access trend reporting to internal stakeholders., • Collaborate with cross-functional teams to ensure alignment on strategy and execution.Qualifications, • Required:, • Demonstrated sales and account management experience., • Team management or leadership experience., • Preferred:, • Healthcare industry experience, particularly in specialty medications., • Understanding of reimbursement dynamics, including payer coverage, prior authorizations, and specialty pharmacy distribution., • Competitive base salary plus bonus opportunity., • Comprehensive health insurance package., • Professional growth opportunity supporting a high-impact specialty drug launch.Pay Rate & Bonus Structure, • Base range $60k-65k

Job Description Position Overview: We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our team. The ideal candidate will have a strong background in pharmacy operations, prior authorization processes, and excellent communication skills. As a Prior Authorization Specialist, you will play a critical role in ensuring that patients receive timely approvals for medications, navigating insurance requirements, and collaborating with healthcare providers to optimize patient care. Responsibilities: • Review prior authorization requests for medications to ensure completeness and accuracy., • Communicate with healthcare providers, insurance companies, and patients to gather necessary information for prior authorization submissions., • Verify insurance coverage and determine prior authorization requirements., • Complete and submit prior authorization forms according to insurance guidelines and requirements., • Follow up on prior authorization requests to ensure timely approvals and resolution of any issues or denials., • Maintain accurate documentation of prior authorization activities and outcomes., • Collaborate with pharmacists, physicians, and other healthcare professionals to optimize medication therapy management and patient outcomes., • High school diploma or equivalent required; Bachelor's degree preferred., • Minimum of 2 years of experience working as a Prior Authorization Specialist in a pharmacy or healthcare setting., • Strong knowledge of pharmacy operations, medication terminology, and insurance processes., • Familiarity with electronic health records (EHR) and pharmacy management systems., • Excellent communication and interpersonal skills., • Ability to work independently and collaboratively in a fast-paced environment., • Attention to detail and strong organizational skills., • Certification as a Pharmacy Technician (CPhT) or similar credential., • Experience working with prior authorization software systems., • Competitive salary commensurate with experience., • Paid time off and holiday pay., • Opportunities

Job Description MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Position Overview: The Pharmacy Intern II is responsible for auditing and validating internal and external reports to ensure proper benefit configuration across all lines of business. The Pharmacy Intern II will also assist in all other Pharmacy department directives. Additionally, the Pharmacy Intern II is responsible for assisting the Clinical Pharmacy Manager with all aspects of formulary management, care management and utilization management strategies across all lines of business. The Pharmacy Intern II will be responsible for improving patient care through various clinical programs, medication reconciliation, counseling and care management in the form of rotations. This resident will have opportunities to develop evidence-based clinical decision making, project management, analytic and leadership skills. Work Shifts 9:00AM-5:00PM Duties & Responsibilities • Reviews daily claims reports of varying focuses across all lines of business to identify and report on the accuracy of the pharmacy benefit configuration., • Review daily rejection reports to identify and report on inconsistencies or concerns that may impact patient care., • Validates improper coding through verification between POS and UM platform systems., • Coordinates care between members, pharmacies, and providers to improve patient adherence for chronic medications and to promote other pharmacy initiatives including assisting with pharmacy case management activities., • Review daily reports to ensure all overrides are inputted correctly and claim adjudication is as intended., • Assists in preparing documentation for internal and external audits and regulatory submissions., • Reaches out to members, pharmacies, and prescribers to reconcile benefit inconsistencies., • Reviews external communications for accuracy and appropriateness., • Assists with prior authorization requests including inputting, providing notification for and reviewing needed., • Complete core and elective rotations, • Assists with formulary and utilization management for medications across all lines of business., • Develop drug monographs and coverage criteria upon request., • Completes retro utilization review for drugs of interest and provides in depth analysis., • Develops and maintains various pharmacy quality initiatives and generates regular monthly reports for key performance indicators., • Provides education to staff on new therapies, new criteria, new guidelines to ensure internal pharmacy staff are versed on up-to-date trends., • Assists in Pharmacy case management programs to improve quality of care and monitoring of MetroPlusHealth members., • Assists in organizational and departmental quality improvement initiativesMinimum Qualifications, • Doctor of Pharmacy required., • Pharmacy experience in a managed care environment is preferred., • Experience in auditing preferred., • Experience in Pharmacy management of government programs (Medicaid and Exchange) preferred., • Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills., • Proficiency with MS Word, Excel, and PowerPoint is required. Experience in the evaluation and interpretation of pharmacy claims data and other clinical data is preferred., • Eligible for licensure in the state of New York (active and not limited Pharmacy Intern License plus Doctor of Pharmacy Degree)., • Integrity and Trust, • Customer Focus, • Functional/Technical Skills, • Position requires excellent organizational, teamwork, interpersonal, time management, written, and verbal communication skills #LI-Hybrid #mhp50