This role supports pharmacy operations by managing billing, reimbursement, and third-party payor requirements while collaborating with healthcare teams to ensure safe and effective drug therapy through patient assessments and outcome monitoring. Responsibilities also include communicating monitoring results, providing consultations, maintaining thorough documentation, and supporting pharmacoeconomic efforts.
Requirements summary
Candidates must possess a B.S. degree in Pharmacy or a Doctor of Pharmacy (Pharm D.) and hold an active Pennsylvania Pharmacist License, with 2+ years of specialty pharmacy experience preferred. Essential qualifications include strong knowledge of specialty pharmacy, problem-solving abilities, good organizational skills, and effective verbal and written communication.
bachelor degreepostgraduate degreeCustomer ServiceTime ManagementDocumentationAdaptabilityProblem SolvingPatient AssessmentBillingActive ListeningStaff EducationPerformance ImprovementElectronic Health Record SystemsReimbursementTherapeutic Drug MonitoringCost-Effective Medication UsePharmacoeconomicsThird-Party Payor Requirements
Job description
Job Summary This role involves supporting pharmacy operations by understanding billing, reimbursement, and third-party payor requirements, as well as the workflow of electronic health record systems at CarepathRx.
The professional collaborates with physicians and healthcare teams to plan and implement safe, effective drug therapy, conducts ongoing patient assessments, and monitors therapy outcomes using clinical and laboratory data.
Responsibilities include communicating therapeutic drug monitoring results, providing consultations to patients and healthcare professionals, and maintaining thorough documentation in compliance with legal and regulatory standards.
The position requires fostering positive relationships with customers and colleagues, handling complaints empathetically, and participating in performance improvement initiatives.
Additional duties encompass supporting pharmacoeconomic programs, ensuring cost-effective medication use, coordinating new referrals, and contributing to staff education and training, all while upholding CarepathRx’s core values and maintaining patient confidentiality.
Schedule Mon-Fri between 8-5:30, 3 shifts 8-4:30, 8:30-5, 9-5:30.
On Call: Remote, one night per week, rotating Training initial training will be onsite then position has option to move to remote/hybrid once complete Essential Functions Understand billing, reimbursement, case management, and other third-party payor requirements/implications for pharmacy products and services.
Understand the workflow of electronic health record systems in use at CarepathRx Assist the physician and other healthcare professionals involved in planning and implementing patient care to ensure safe and effective drug therapy.
Conduct initial and ongoing assessment of specific patient drug and disease information to identify real and potential drug-related problem or needs.
Assist the physician and office staff in setting therapeutic objectives for drug therapy and establishing parameters for monitoring the safety and efficacy of drug therapy.
Monitor the outcomes from drug therapy by collecting, evaluating, and interpreting the results of laboratory data, clinical data, and other pertinent patient information.
Communicate the results of therapeutic drug monitoring activities to the physician, nursing and other appropriate personnel.
Make appropriate recommendations which are designed to enhance the outcomes associated with drug therapy.
Benefits
Paid Holidays
Dental
Vision
Paid Time Off
Health Insurance
401(k)
Tuition Reimbursement
Company Paid Life Insurance
Well-being And Behavioral Health Programs
Provide consultations and answers inquiries from patients, families, physicians, and other healthcare professionals regarding and their use.
Maintain thorough and appropriate documentation in the patient/client record of all clinical activities and communication with patients, physicians and other healthcare professionals.
Demonstrate the ability to work effectively and maintain expected productivity.
Process and checks all medications prior to dispensing from the pharmacy.
Maintain pharmacy records in accordance with applicable laws and regulations.
Carry out all responsibilities in accordance with CarepathRX's Core Values.
Experience a strong knowledge base in Specialty pharmacy.
Capable of assuming responsibility for evaluating and monitoring drug therapy relative to the total needs/problems of the home care patient in collaboration with physicians, nurses, and other healthcare professionals.
Attend regular staff meetings to gather and disseminate information.
Establish positive working relationships with internal and external customers.
Meet expectations for customer satisfaction and anticipates customer needs.
Handle customer complaints in a fair and empathetic manner.
Cooperate with other staff members when planning and organizing pharmacy services.
Maintain confidentiality of patient information.
Participate in CarepathRx’s Performance Improvement Program.
Promote CarepathRx culture by providing quality, comprehensive services to all customers through a team approach.
Assist with development and enforcement of policies and procedures that promote cost-effective, appropriate, and safe medication use.
Support the pharmacy's pharmacoeconomic efforts.
Review the use of targeted medications for compliance with current pharmacoeconomic programs.
Issue controlled substances to patient care areas and maintain records as required by law.
Assist with pharmacokinetics consult service and drug dosing per organizational protocol.
Participate in the development and presentation of orientation, education and training programs to the pharmacy, nursing, and other staff.
Foster a team environment by providing orientation and training to new team members.
Work cooperatively with all staff.
Communicate issues to appropriate persons in a positive manner.
Act as a resource for clinical pharmacy staff.
Prioritize required activities.
Understand and adhere to all applicable State, local and federal laws and /or regulations, company policies and procedures, external accreditation / review standards.
Strive to achieve cost effectiveness in all areas (including purchasing /inventory control, staffing, delivery services).
Maximize the efficiency and productivity of the pharmacy and delivery operations.
Coordinate and facilitate new referrals/admissions through collaboration with nursing, admissions, operations and sterile products. *Performs in accordance with system-wide competencies/behaviors. *Performs other duties as assigned.
Qualifications B.S. degree in Pharmacy or Doctor of Pharmacy (Pharm D.) required.
2+ year's previous experience in specialty pharmacy services is preferred.
Pennsylvania Pharmacist License Must be flexible with work schedule.
Demonstrate ability to solve problems and supervise technical and support staff.
Good organizational and time-management skills.
Clearly and effectively communicates both verbally and in writings.
Communicates in a timely manner and is capable of active listening.
Receptive to new ideas and view of others.
Adaptable to fast paced and often evolving environment.
Licenses and Certifications Pharmacist.
Certification in Specialty Preferred.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an hourly rate of 54 - 91 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.
Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.
For more details on our employee benefits programs, click here.
About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives.
At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve.
Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients.
Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support.
Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible.
Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment.
These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Doing something meaningful starts with a simple decision, a commitment to changing lives.
At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve.
Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients.
