pbm pharmacy benefit manager rxclaim Jobs

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PBM Network Management SME

nTech Solutions

•

Remote

Contract

Terms of Employment: W2 Contract-to-Hire, 12 MonthsThis position is remote.Overview: Join a leading managed care organization and take charge of our pharmacy network operations. In this crucial role, you will oversee our relationships with various pharmacy network partners (retail, mail, specialty) to ensure they meet contractual, regulatory, and service-level standards. This is a non-technical, operational management position focused on performance, compliance, and optimization. You will Manage
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Posted 60+ days ago | Updated 6 days ago

Technical Product Owner - Preferred Drug List (PDL) / Pharmacy Benefits Management (PBM) - W2 only

cloudingest inc

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Remote

Contract

Technical Product Owner Preferred Drug List (PDL) / Pharmacy Benefits Management (PBM)No. of positions: 1Client Location: Onshore, USMode of work: Remote-first with flexibility for in-office collaboration, Occasional evening and weekend work.Work Time Zone: EST or CST Job Summary: We are looking for a results-driven Technical Product Owner (TPO) with strong healthcare domain expertise and a hands-on technical background to lead the development of Preferred Drug List (PDL) solutions. This role d
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Posted 1 day ago | Updated 1 day ago

PBM Program Director -- W2 ONLY

nTech Solutions

•

Remote

Contract

NO C2C NO C2C NO C2C NO C2C NO C2C NO C2C Title: PBM Program Director Location: 100% Remote (Candidates must reside in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas.) Terms of Employment: W2 Contract-to-Hire, 12 Months This is a 100% remote position. Candidates must reside in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas
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Posted 19 days ago

Financial Planning Analyst (PBM Supply Chain) -Fully Remote

Elite Technical

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Remote

Contract, Third Party

Candidates must have PBM ( Pharmacy Benefits Management) experience this means they must have worked at PBM companies such as Walgreens, CVS etc. Third parties-absolutely no phone calls please Candidates must be willing to go direct after one year without a sponsor. Must reside in an approved state. Location: 100% remote, approved states only. DC, MD, VA, WV, NC, PA, DE, NY, NJ, TX, FL. Our direct client is seeking a Financial Planning Analyst (PBM Supply Chain) for a long term engagement. Edu
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Posted 14 days ago | Updated 14 days ago

Remote - Kogito Developer

GRT Corporation

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Remote

Contract

Job Title: Kogito Technical Lead / Senior Developer Location: Remote] Experience Required: 56+ years in Java development, 35+ years in Kogito BPM Education: Bachelors degree in Computer Science, Software Engineering, or a related field Job Summary: We are seeking an experienced Kogito Technical Lead / Senior Developer to join our engineering team. This role is responsible for designing, developing, and deploying cloud-native applications using the Kogito framework for process automation and deci
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Posted 22 days ago | Updated 21 days ago

RxCLAIM SME

Endava

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Remote

Full-time

What You Will DoAct as a subject matter expert in pharmacy benefit plan design across RxCLAIM or similar adjudication platforms.Create Current state flows for each functional component and their interactions with benefit build process within RxCLAIM and downstream applications.Develop and document plan designs including tier structure, copays, accumulators, exclusions, step therapy, quantity limits, and PA requirements.Collaborate with actuarial, clinical, and compliance teams to ensure benefit
Posted 6 days ago

PBM Intergration Consultant

York Solutions, LLC

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Remote

Contract

Summary We are seeking two experienced Business Integration Principals to support the implementation of a large national health plan client. These individuals will each own a high-level workstream composed of approximately 10 sub-tracks (e.g., adjudication, operations, etc.), and be responsible for driving deliverables, facilitating internal and external coordination, and maintaining client confidence through proactive issue management and executive communication. This role is ideal for a senior
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Posted 2 days ago | Updated 5 hours ago

Software Engineering Senior Advisors- Hybrid

Cigna

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Remote or Morris Plains, New Jersey, USA

Full-time

The job profile for this position is Software Engineering Senior Advisor, which is a Band 4 Contributor Career Track Role with Cigna-Evernorth Services Inc. Responsibilities- Write and modify complex software application programs, and lead work groups responsible for software development, design, documentation, troubleshooting, and quality testing of contact center applications.Support and enhance applications used by consumers and internal call center agents.Assist in preparing for the adoptio
Posted 34 days ago | Updated 9 hours ago

Pharmacy Business Analyst - Conversion & Prior Auth SME

Gainwell Technologies LLC

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Kansas City, Missouri, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary As a Pharmacy Business Analyst - Conversion & Prior Auth SME at Gainwell, you can contribute your skills as we harness the powe
Posted 28 days ago | Updated 6 hours ago

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

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Austin, Texas, USA

Full-time

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work
Posted 49 days ago | Updated 6 hours ago

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

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Dallas, Texas, USA

Full-time

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work
Posted 49 days ago | Updated 6 hours ago

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

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Houston, Texas, USA

Full-time

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work
Posted 49 days ago | Updated 6 hours ago

Lead OT System Support Engineer

UnitedHealth Group

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Chandler, Arizona, USA

Full-time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us
Posted 35 days ago | Updated 9 hours ago

Network Management - Senior Analyst

CVS Health

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Arizona, USA

Full-time

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all w
Posted 21 days ago | Updated 9 hours ago

Sr Manager, Software Development Engineering

CVS Health

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Remote or Richardson, Texas, USA

Full-time

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all w
Posted 13 days ago | Updated 9 hours ago

Principal, PBM Operations Business Process Engineering

Gainwell Technologies LLC

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Columbus, Ohio, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Your role in our mission Primary point of contact for the Pharmacy Clinical Operations organization, operational and process excellence
Posted 14 days ago | Updated 6 hours ago

Sr. Analyst, Network Pricing Management

CVS Health

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Arizona, USA

Full-time

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all w
Posted 10 days ago | Updated 9 hours ago

Staff Software Development Engineer

CVS Health

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Remote or Buffalo Grove, Illinois, USA

Full-time

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all w
Posted 26 days ago | Updated 9 hours ago

Senior Automation Engineer

CVS Health

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Remote or Northbrook, Illinois, USA

Full-time

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all w
Posted 60+ days ago | Updated 9 hours ago

Sr. Full Stack Developer - 100% remote from anywhere in the US

Calance

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Remote or New York, New York, USA

Full-time

Senior Full Stack Software Developer Position Responsibilities: Exercise leadership over all team products from design to production. Work with product managers and designers to refine requirements before implementation. Demonstrate technical leadership at a team level driving on time execution and software delivery. Represent software development team s products technically to stakeholders. Demonstrate ownership and responsibility for team products throughout their production lifecycles. Inter
Posted 60+ days ago | Updated 7 hours ago