by twochickswithasidehustle | Nov 29, 2023 | Uncategorized
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Director, Specialty Clinical Solutions- REMOTE
Job Description Summary
Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Business Development team. Responsible for managing current Medical Pharmacy clients and potential new clients. Required to serve as a Medical Pharmacy clinical resource throughout the organization and support all clinical pharmacy programs involving Medical Specialty medications and additional clinical programs as needed. Expected to assume leadership of projects as assigned by VP, Medical Pharmacy Strategy.
Job Description
Supports overall Medical Pharmacy Product line for health plans through validated program enhancements, creation of usable, client collateral materials with marketing, and onsite client presentations
Leads evaluation and identification opportunities for improved management of Medical benefit drugs through clinical research and analytics that improve medical cost savings and provide clinical quality initiatives
Manages current clients in all Medical Pharmacy programs such as Fee Schedule Management, Prior Authorization, Post Service Claim Edits, Site of Service and any additional programs.
Develops new opportunities and expands programs for existing clients.
Works with analytics team to provide business rules and develop new drug to market cost impact analyses for health plan clients
Manages Medical Pharmacy development needs for potential new clients.
Identifies and develops opportunities for improved process efficiencies for Medical Pharmacy programs.
Identifies enhanced reporting methodologies for Medical Pharmacy Programs.
Supports development and production of Medical Pharmacy Trend Report, owning specific sections as delegated
Supports development, production and monitoring of Specialty Pharmacy Pipeline Report.
Communicates and collaborates effectively with all internal stakeholders
Provides Medical Pharmacy expertise within the organization to other business units and within Magellan Rx
Develops potential opportunities and all research and materials for presentations at National pharmacy/healthcare industry meetings, white papers and published papers.
Develops appropriate submissions for program presentations at National meetings and for publication acceptance.
Responsibilities
7+ years of pharmacy, managed care and pharmaceutical industry experience.
At least 1-2 years’ Health Plan Pharmacy experience with knowledge of Medical Pharmacy benefit management strategies.
Strong interpersonal, consultation, organizational, tracking and follow-up skills.
Pharmacy, Managed Care, Pharmaceutical Industry experience.
Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
Excellent verbal and written communication skills.
Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA-National Committee for Quality Assurance, and ERISA-Employee Retirement Income Security Act of 1974).
Requires an in depth understanding of the pharmacy industry including drugs paid for on the medical benefit and pharmacy benefit.
Generates high confidence in project output and production.
Independent worker requiring little oversight, self motivated.
Strong communication and presentation skills.
Experience and thorough understanding of Microsoft Office products, and other relevant software systems and applications.
Data review and interpretation skills required.
Must possess RPh or PharmD license in good standing.
Health Plan experience managing drugs on both Pharmacy and Medical benefit.
Work Experience
Work Experience – Required:
Managed Healthcare, Pharmacy
Work Experience – Preferred:
Education
Education – Required:
Bachelors – Pharmacy
Education – Preferred:
PharmD – Pharmacy
Certifications
Certifications – Required:
RPH – Registered Pharmacist – Pharmacy – Pharmacy
Certifications – Preferred:
PharmD – Doctor Of Pharmacy, State Licensure – Pharmacy – Pharmacy
by twochickswithasidehustle | Nov 29, 2023 | Uncategorized
Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Quality Specialist II
Job Description Summary
Serves as a member of the quality team at the national, regional or unit level. Coordinates projects resulting in continuous quality improvement and process improvement. Supports the maintenance of a strong quality program, measured processes including URAC, NCQA, and/or HEDIS (where applicable) and reported outcomes.
Job Description
2+ years of quality improvement and auditing or related in healthcare field.
2+ years of HEDIS related experience (where applicable).
Coordinates assigned quality and process improvement activities which may include accreditation support, process improvement projects, quality studies, CQI (continuous quality improvement) process training for staff, prevention program coordination, care coordination initiatives, satisfaction survey coordination and follow-up, provider and member advisory groups (where applicable), tracking of adverse incidents, monitoring of performance guarantees, CAPs and customer related quality initiatives.
Knowledgeable in HEDIS (where applicable) and Accreditation (NCQA and/or URAC) requirements.
Conducts quality control reviews and external/internal audits.
Summarizes findings and prepares reports on findings.
Assists in the preparation of customer audits.
Conducts analyses of data findings for quality and process improvement and assists in report preparation for internal and external customers.
Leads and/or supports assigned quality committees and/or work groups through comprehensive project management, ensuring that documentation is accurate and timely, agenda items presented, and follow-up actions taken.
Supports the quality program with the goal to meet customer requirements and performance guarantees. Duties include monitoring and execution to meet timely deliverables.
Works independently and high degree of organization required.
Knowledge of healthcare quality improvement processes, accreditation standards, and HEDIS/performance measurement.
Attention to detail and ability to work efficiently to meet deadlines and timelines.
Expertise in data management, data analysis, reporting word processing, and project management skills.
Strong working knowledge of Microsoft Excel, VISIO, and/or MS Project.
Excellent verbal and written skills and the ability to enter data accurately into spread sheets and prepare professional looking documents and reports.
Responsibilities
2+ years of quality improvement and auditing or related in healthcare field.
Knowledge of healthcare quality improvement processes and performance measurement.
Attention to detail and ability to work efficiently to meet deadlines and timelines.
High degree of organization required.
Expertise in data management, data analysis, reporting word processing, and project management skills.
Strong working knowledge of Microsoft Excel, VISIO and MS Project.
Work Experience
Work Experience – Required:
Quality
Work Experience – Preferred:
Education
Education – Required:
Education – Preferred:
Bachelors – Healthcare
Certifications
Certifications – Required:
Certifications – Preferred:
LSSGB – Lean Six Sigma Green Belt Certification – Enterprise – Enterprise, LSSWB – Lean Six Sigma White Belt Certification – Enterprise – Enterprise
Potential pay for this position ranges from $54,190.00 – $86,690.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.
by twochickswithasidehustle | Nov 28, 2023 | Uncategorized
Description
At Bath & Body Works, everyone belongs. We are committed to creating a diverse, equitable and inclusive culture focused on delivering exceptional fragrances and experiences to our customers. We focus on recruiting, retaining, and advancing diverse talent where our associate population is as diverse as the communities we serve, live and work. In addition, we work to improve our communities and our planet in a way that will make us proud for years to come because we believe the world is a brighter, happier place when everyone has access to the things that make them happy.
Summary:
HR Direct is a remote call center environment responsible for receiving and advising incoming calls regarding human resources-related employee inquiries. You will be responsible for providing 1st level functional support in answering benefit and payroll questions and supporting associates with personal and job-related transactions.
Responsibilities:
- Assisting all associates calling HR Direct to complete Personal data, Job data and Benefit-related transactions in HR Access
- Provide support to associates using the web application on-line to complete their transactions.
- Answer benefit and payroll questions
- Coordinate with other functional groups within HR Direct as vital
- Provide a high level of functional support to callers needing assistance with ESS and MSS and store managers entering HR data transactions in store
- Assist with the greater HR team with data transactions and inquiries while documenting all calls in HR Direct call tracking system
- Engage Service Coordination Supervisor for issue resolution as needed
Qualifications
- 1-2 years’ Service Center environment (call center) experience required, with HR, payroll, or benefits experience a plus
- Providing superb customer service to all customers
- Must be highly proficient in utilization on dual monitors and computer software and applications including Microsoft Office
- Excellent communication skills both written and verbal
- Solid attention to detail and accuracy
- Ability to work in a team environment to achieve goals
- Proficiency in Spanish and/or French (verbal and written) ideal
Education:
- Bachelor’s Degree preferred, but not required
Core Competencies:
- Lead with Curiosity & Humility
- Build High Performing Teams for Today & Tomorrow
- Influence & Inspire with Vision & Purpose
- Observe, Engage & Connect
- Strive to Achieve Operational Excellence
- Deliver Business Results
Benefits:
We invite you to join Gingham Nation, where we invest in our associates through competitive compensation, benefits, and development opportunities, so they can continue to be their best at work, at home, and in their communities. Benefits offered to our eligible associates include a no cost mental health and well-being program, health coverage with a variety of plans to choose from, flexible and affordable saving programs, paid time off and a merchandise discount. Visit bbwbenefits.com for details.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required.
We are an equal opportunity and affirmative action employer. We do not make employment decisions based on an individual’s race, color, religion, gender, gender identity, national origin, citizenship, age, disability, sexual orientation, marital status, pregnancy, genetic information, protected veteran status or any other legally protected status, and we comply with all laws concerning nondiscriminatory employment practices. We are committed to providing reasonable accommodations for associates and job applicants with disabilities. Our management team is dedicated to ensuring fulfillment of this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, associate activities and general treatment during employment. We only hire individuals authorized for employment in the United States.
by twochickswithasidehustle | Nov 28, 2023 | Uncategorized
- Wrapify
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by twochickswithasidehustle | Nov 27, 2023 | Uncategorized
3Play Media is a rapidly growing provider of video accessibility services, with our home base located in the North End neighborhood of Boston. We’re looking for motivated, energetic, and creative candidates who are excited to help us transform the way people access video.
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