Specialty Pharmacy Resume Samples

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D Powlowski
786 Leda Mount
+1 (555) 370 1118
786 Leda Mount
p +1 (555) 370 1118
Experience Experience
12/2016 present
Dallas, TX
Regional Account Manager, Specialty Pharmacy
Dallas, TX
Regional Account Manager, Specialty Pharmacy
12/2016 present
Dallas, TX
Regional Account Manager, Specialty Pharmacy
12/2016 present
  • Creates relationships with manufacturers
  • Make cold calls
  • Develop territory sales plan
  • High quality work, organized with attention to detail
  • Business Acumen-Specialty Medication and Therapy Management
  • Manage territory T&E and customer related expenses
  • Excellent communicator both verbal and written
06/2014 10/2016
Los Angeles, CA
Specialty Pharmacy Program Manager
Los Angeles, CA
Specialty Pharmacy Program Manager
06/2014 10/2016
Los Angeles, CA
Specialty Pharmacy Program Manager
06/2014 10/2016
  • Lead the planning, tracking and implementation of Specialty Pharmacy programs by serving as the business unit liaison with cross functional teams
  • Develops and implements standard operating procedures to ensure efficient delivery of products and services including billing and collections
  • Generates weekly detailed reporting and inventory reporting for manufacturer contracts
  • Liaison with the SP Customer Facing Team to gather insights from SPs, deploy programs, and monitor contract performance and quality
  • May manage vendor and service providers to define project scope and performance expectations. Incumbents maybe part of a project management office (PMO) in their business
  • Responsible for the management and growth of current products and ensure timely reviews, updates, and enhancement of existing programs
  • Serve as the primary point of contact for the Brand team for programs across all SPs on implementation of contracted programs, including operations and performance management
08/2011 12/2013
Detroit, MI
Pharmacist, Specialty Pharmacy
Detroit, MI
Pharmacist, Specialty Pharmacy
08/2011 12/2013
Detroit, MI
Pharmacist, Specialty Pharmacy
08/2011 12/2013
  • Triages work flow in and between all areas, along with and if necessary in the absence of management
  • Performs all duties and functions in compliance with state and federal pharmacy laws and regulations
  • Performs Quality Assurance final verification of medications, information, and supplies, ensuring accuracy of patient order contents prior to dispense
  • Assists non - clinical employees by answering questions related to medication therapies
  • Supervises and educates pharmacy technicians ensuring Continuous Quality Improvement
  • Demonstrates competence in patient management, fulfillment, and clinical areas
  • Performs other duties as assigned within scope of practice
Education Education
Bachelor’s Degree in Collaboration Across Account Teams
Bachelor’s Degree in Collaboration Across Account Teams
Iowa State University
Bachelor’s Degree in Collaboration Across Account Teams
Skills Skills
  • Strong attention to detail
  • Strong organizational and time management skills; keen attention to detail
  • General knowledge of reimbursement principles, pharmacy operations and medical claims
  • Strong mathematical skills
  • Strong interpersonal skills
  • Ability to work independently, within a team environment
  • Strong negotiating skills
  • Demonstrated proficiency with Microsoft Excel (intermediate level), Outlook and Word
  • Written Communications:Ability to communicate clearly and effectively in written English with internal and external customers
  • Strong attention to
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Specialty Pharmacy Testing Front Line Leader Resume Examples & Samples

  • Progressive work experience in an operational setting, with demonstrated supervisory experience
  • Applied knowledge of insurance processing and technical processes and practices
  • Associate’s or Bachelor’s Degree of Art or Science

Humana Specialty Pharmacy Call Center Manager Resume Examples & Samples

  • Provide guidance to a team of 8-10 frontline supervisors who manage day to day operational activities for their teams of approximately 150 front line associates
  • Identify issues and work with partners to identify / implement resolutions
  • Act as a liaison between call center operations and other functional areas
  • Identify and address barriers cross functionally that inhibit Humana Specialty Pharmacy from providing exceptional customer service
  • Provide ongoing coaching and feedback that enhances the contribution and performance of front line associates and leaders
  • Implementation of projects and processes that help solve complex organizational problems
  • Select competent and diverse talent to ensure best possible outcomes for customer service to members
  • Bachelors degree in Business, Finance, Operations or other related fields / or 10 years Customer Service Management experience
  • Operational experience in leadership role
  • Leadership experience over a large metric-intensive operational unit with a span of control between 80-200 associates
  • Certification in Six Sigma or Project Management
  • Prior Experience in healthcare or insurance setting

VP, Specialty Pharmacy Strategy Resume Examples & Samples

  • Develop personal/professional alignment with Humana’s Integrated Care Strategy – specifically, the commitment to lead and develop the Specialty Pharmacy team focused on the highest quality service and care for our members
  • Develop comprehensive knowledge of Humana’s Corporate Organization, the Healthcare Services Segment, the Group Segment, and the Retail Segment, and the interdependent service-driven relationships between these organizations that drives Humana’s success
  • Assume shared responsibility for the financial performance of Humana Specialty Pharmacy, including the development of a budget and strategic plan aligned with the Humana Pharmacy Solutions mission/growth objectives
  • Develop trust and credibility with cross-functional corporate and field-based leaders to maintain “One Humana” goals
  • Ensure linkages (upstream and downstream interfaces) between corporate, market based activities which regularly communicate Specialty Pharmacy initiatives, programs and decisions
  • Collaborate with several components inside the PBM to achieve many important strategies, including forecasting, research, analytics, network contracting, manufacturer contracting, and potential business development opportunities, among others
  • Regularly look forward into the future to innovate drug formulary, benefit design, bio-similar, and site of care strategies (among others)
  • Regularly assess current state of Humana Specialty Pharmacy against industry standards for productivity, quality, and cost. Partner with the field based sales organization to identify key markets of influence at a geographic and/or disease areas, amongst other dimensions
  • Recruit, select and develop a highly functional team dedicated to transformation of processes which impact Humana Specialty Pharmacy initiatives and programs. Provide the leadership necessary to maintain a motivated, productive and engaged team through open communication, rewards/recognition and delegation of responsibilities and authority
  • Act a progressive thought leader on Health Care Reform initiatives and Humana’s approach to improving our health care system; promote Humana’s mission to internal and external audiences
  • Lead a world class organization providing exceptional service, differentiating Humana as a preferred choice for “Integrated Care Delivery” nationally

Specialty Pharmacy Contracting Leader Resume Examples & Samples

  • Knowledge and subject matter expertise in the specialty pharmaceutical FDA approval process, specialty pharmaceutical manufacturer contracting, data service revenue fair-market-value determination, GPO class of trade differences, bio-similars, industry best practices and specialty pharmacy industry pricing benchmarks
  • Effectively manage Humana’s specialty pharmaceutical manufacturer relationships and contracting to ensure timely access to existing & new specialty products and to maximize cost of goods reduction & data service revenue opportunities
  • Collaboratively negotiate and execute specialty pharmaceutical manufacturer agreements with Humana Specialty Pharmacy, Corporate Legal and Corporate Procurement team members
  • Effectively manage the specialty pharmaceutical manufacturer contract review, negotiation and implementation process to ensure efficient and timely execution and implementation of contracts, terms and reporting
  • Track & communicate the progress and timeliness of the review, negotiation, execution and implementation of specialty pharmaceutical manufacturer contracts
  • Summarize and track specialty pharmaceutical manufacturer contractual agreement terms, obligations, pricing, data service revenue details
  • Develop and maintain reports & reporting systems to track, monitor, and report on Humana’s specialty pharmaceutical product access, prescription time-to-fill, purchases, pricing, cost of goods sold and gross margin metrics
  • Track and report on Humana’s and supplier’s contractual performance metrics (e.g. time-to-fill, reporting, accuracy, payment terms, etc.)
  • Monitor and report on Humana’s specialty pharmaceutical purchases, current pricing, DSR opportunities, cost of goods sold projections and gross margin metrics
  • Leverage price benchmarking and competitive bid mechanisms to ensure Humana’s specialty pharmaceutical pricing and data service revenue agreements are competitive across different sources of supply and pharmacy classes of trade
  • Work with Pharmacy Operations teams to facilitate specialty pharmaceutical supplier site visits and business reviews to discuss performance, product access, product pipeline and to maximize DSR opportunities
  • Manage day-to-day activities associated with Humana’s specialty pharmaceutical manufacturer relationships
  • Ensure the appropriate storage & team access to all Humana Specialty Pharmacy manufacturer agreements
  • Track and communicate industry trends and events that may impact Humana’s pharmaceutical supply chain
  • Maintain processes, methodologies and tools to forecast and model financial opportunities and communicate with stakeholders
  • Attend industry tradeshows and various manufacturer meetings at off-site locations or at Humana’s facilities
  • Bachelor’s Degree in Nursing, Pharmacy, Finance or Related Field
  • 3-5 Years of Specialty Pharmacy Contracting, Pharmaceutical Industry or Pharmacy Supply Chain Work Experience
  • Intermediate or Advanced Proficiency in MS Excel, Access and Other Data Mining & Analysis Tools
  • Previous Specialty Pharmaceutical Contracting or Specialty Pharmaceutical Manufacturer Account Management Experience Preferred
  • PharmD, MBA or Nursing Degree Preferred

Humana Specialty Pharmacy Dispensing Clerk Resume Examples & Samples

  • High School Diploma or Equivalent
  • Ability to work around pharmaceutical products
  • Able to use material handling devices (pallet jack, hand carts, etc.)

Specialty Pharmacy Territory Manager Resume Examples & Samples

  • Previous experience working in sales with documented success
  • Flexible, dynamic personality who works well in a team environment
  • Must be comfortable with approx. 75% travel
  • Experience with Pharmacy reporting or the Pharmaceutical industry
  • Self-motivation
  • Exposure to pharmaceutical contracting language

Specialty Pharmacy Billing Technician Hmc Resume Examples & Samples

  • Review and screen new patients at intake to determine if patient has adequate prescription coverage. Refer appropriate patients to financial counseling for coverage or charity application
  • Provide customer service through the Specialty Pharmacy Call Center. Triage patient calls to appropriate party
  • Provide monthly adherence phone calls to patients
  • Contact Department of Health and caseworkers and patients with regard to missing documents for insurance plans
  • Work with financial counselors, HRSA, social workers, financial advocates and patients to monitor and review patients in spend-down or pending DSHS status. Review pending reports from pharmacy management system and rebill claims when coverage is granted
  • Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate carrier for all commercial, federal, and state insurance plans. Submit prior authorization requests, follow up on submitted prior authorization requests and submit claims with approvals as appropriate
  • Assist with prescription audits
  • Participate in the Specialty Pharmacy quality management program as part of the Specialty Pharmacy Committee
  • Establish and maintain good working relationships with billing operations specialists and Outpatient Clinic pharmacy staff to maintain effective communication regarding third-party billing issues
  • Educate pharmacy staff about third-party billing policies and procedures as needed
  • Assure that policies and procedures are followed in coordination with the Billing Operations Specialists, Leads, Manager and Director

Specialty Pharmacy Solutions Coordinator Resume Examples & Samples

  • Ensures an optimal prescription fulfillment service focusing on the coordination and scheduling of on time delivery, reporting, invoicing, ordering, data integrity and communication
  • Ensures accurate and timely coordination services activities in compliance with internal and external expectations
  • Communicates directly with pharmacies and other service providers to ensure the needs of the patients are met
  • Minimum of two years of related experience and/or on Customer Service
  • Technologically Savvy- knowledge of CRM databases a plus!
  • Demonstrate superior customer service skills
  • Exhibit a good understanding of ABS Canada services and client base
  • Strong verbal and written communication skills, interpersonal skills and attention to detail
  • Ability to make decisions using sound judgment and take initiative with minimal direction
  • Ability to work well within a team-based environment

Corporate Director, Specialty Pharmacy Resume Examples & Samples

  • Develops and manages all key Specialty Pharmacy operations, including, but not limited to: a) benefits verification b) referral and order entry c) pharmacy and medical coverage eligibility d) prior authorizations e) billing and collections f) dispensing and shipping g) purchasing and inventory control h) specialty therapy management and i) payor contract management
  • Interacts with the PHS Specialty Pharmacy Advisory Board and steering group. Meets with other organization pharmacy leaders, medical staff, and senior executives to assure that the Specialty Pharmacy is fulfilling the strategic goals of the organization and operations are being executed in accordance with organization’s policies
  • Manages an effective system of communication with each hospital entity. Builds and executes focused marketing and communication initiatives to help patients and physicians, recognize and easily utilize the services of Partners Specialty Pharmacy
  • Reviews, revises, and assures that Specialty Pharmacy policies and procedures comply with state and/or local regulations and meet the professional standards of accreditation organizations such as TJC, ACHC and URAC
  • Works with health plans, other insurers, pharmacy benefit managers, and other third party programs to coordinate Specialty Pharmacy and associated Disease Management Services, relevant provider fee schedules, dual coverage issues, and client reporting activities
  • Doctorate of Pharmacy (Pharm D)
  • Experience in operational leadership and team management within a specialty pharmacy and/or ambulatory pharmacy, particularly at an Academic Medical Center
  • Minimum of 5 to 7 years of experience with a proven track record of successful operational and financial leadership in the healthcare field
  • Eligible for licensure to practice pharmacy in the State of Massachusetts
  • Advanced Degree (i.e. MBA, MPH, MHA) or equivalent professional experience preferred
  • Demonstrated Pharmacy leadership and clinical experience
  • A demonstrated track record of improving operational efficiencies and achieving financial target goals
  • Strategic thinker with ability to translate into operating programs
  • Capable of interacting with multiple levels of an organization (Senior Leadership, MDs, etc.) and handling multiple complex situations simultaneously
  • Strong influencing and decision making abilities; comfortable in a consensus building environment
  • Strong business and financial acumen with prior experience managing budgets and profit and loss statements
  • Knowledge of specialty pharmacy reimbursement as well as payer and manufacturer contracting
  • Understanding of state and regional regulations; familiarity with the requirements of accreditation organizations such as TJC, ACHC and URAC
  • Knowledge of the health informatics business and value of orals data to bringing data solutions to interested constituents

Product Manager Specialty Pharmacy Resume Examples & Samples

  • Manages the product life cycle from the strategic planning perspective
  • Develops product enhancements based from the “voice of the customer” and is the expert on users and their requirements
  • Collaborates with end users to determine needs and requirements, as well as features, and functionality to meet their needs
  • Defines scopes, creates, and positions new products and existing product enhancements based on the company’s capabilities, competencies, and strategic fit to maximize sales revenue, market share, and profit
  • Drives and facilitates stakeholder consensus around scope and priorities where multiple opinions and needs exist
  • Responsible for determining the high-level requirements (epics/themes) that are part of the product roadmap and release plan in conjunction with other stakeholders
  • Works with Technical Product Owners to capture epics/themes for expansion by the team
  • Provides the expected benefits as part of initiative ROI analyses and helps the Service Lead prepare documentation necessary for investment approvals. Supports the development team in the effort to design the simplest possible solution to the business need
  • Works with non-acute business partners to create awareness of relevant Vizient offerings for Provista Sales
  • Work with support, sales and marketing to highlight the customers’ needs and wants
  • Minimum of BS degree in business related field of product development in field or related field preferred
  • Agile/Scrum experience
  • 5+ years of software marketing and or product management experience
  • Knowledge of healthcare, GPO business and non-acute environment
  • Knowledge of pharmaceutical supplies and pharmacy operations
  • Ability to synthesize market and customer feedback and translate into new product solutions; comfortable with making trade-offs, decisively
  • Expertise delivering complex projects to meet demanding feature, cost, quality and introduction date targets
  • Demonstrable communication skills and ability to lead an organization to develop market leading products/solutions
  • Must be flexible with a “can do” attitude and have the ability to remain professional under high pressure situations
  • The position requires 25% travel within North America to current and potential customer sites as well as various industry events

Senior Mgr, Specialty Pharmacy Resume Examples & Samples

  • Provides strategic and tactical oversight and leadership to the specialty pharmacy team
  • Oversees the dispensing of medication to patients in a timely manner. Oversees staff regarding dispensing prescriptions, verifying written prescriptions, DUR and medication fulfillment
  • Oversees patient benefit investigations
  • Communicates with patients and physicians via phone, fax and email to resolve prescription issues and to assist in the prior authorization process
  • Ensure compliance for all state and federal regulations and guidelines as they pertain to specialty pharmacy
  • Creates financial reports and conducts audits through sales, AR and inventory reports. Performs revenue reconciliation and participates in CQI activity
  • Provides clinical expertise in patient consultation
  • Supports Marketing activity through script capture and customer retention data
  • Creates, implements and monitors department and individual metrics
  • Manages staff schedule and sets performance goals and objectives. Creates and conducts performance reviews
  • Determines and schedules after hours support
  • Performs special projects as needed.*LI-KM1
  • Preferred A Doctor of Pharmacy (PharmD)
  • Required 5+ years of experience in a licensed pharmacy role
  • Required 2+ years of management experience
  • Required Other Previous mail order pharmacy or home infusion pharmacy experience
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Other Ability to evaluate information and develop clear, concise and crisp reports
  • Intermediate Other Ability to use pharmaceutical and medical reference, literature to provide drug information to the health plan
  • Required Other Current unrestricted pharmacy license in state of operation
  • Preferred Other Consultant pharmacy license
  • Required Intermediate Microsoft Word Solid use of Microsoft products including Word, Excel, and Power Point
  • Required Intermediate Healthcare Management Systems (Generic)

Specialty Pharmacy It-call Center System Analyst Resume Examples & Samples

  • Lead requirements gathering, service-oriented modeling, analysis and design activities
  • Evaluate business requirements and prepare detailed functional and technical specifications
  • Communicate design to all stakeholders and varying levels of the organization
  • Present and evaluate design solutions objectively and facilitate conflict resolution
  • Define, use and communicate design patterns and best practices in service oriented analysis, design and development
  • Collaborate with quality assurance team to ensure testing efforts align with system deliveries and business processes
  • Responsible for supporting new development and enhancements of the Navigator application for the Specialty Pharmacy line of business
  • Bachelors Degree or equivalent work experience
  • 3+ years of experience in Systems Analysis or IT Development
  • 3+ years of experience in all phases of Software Development Life Cycle (SDLC) / System Development Life Cycle
  • 3+ years of experience translating business requirements into a detailed system specification
  • 3+ years of Relational Database experience

Specialty Pharmacy Sales Associate Resume Examples & Samples

  • Building relationships with physician’s offices that deal with complex chronic diseases such as Cancer, Hepatitis C, MS, Rheumatoid Arthritis, and Crohns Disease
  • Within your assigned territory use effective communication via phone, email, fax, and WebEx, to consistently move customers or prospects toward commitment of using BriovaRx as their specialty pharmacy
  • Associate's Degree or Higher
  • 2+ years sales experience with documented success
  • Track record of over- achieving quotes
  • Strong phone presence and experience with cold calling
  • Ability to multi-task, prioritize, and manage time effectively

Regional Account Manager Specialty Pharmacy Resume Examples & Samples

  • Develop territory sales plan
  • Use consultative sales process, probe for customer information and barriers
  • Creates relationships with manufacturers
  • Close sales
  • Serve needs of medical practice accounts and solve issues
  • This is a commission eligible position
  • Business Acumen-Specialty Medication and Therapy Management
  • Excellent communicator both verbal and written
  • Easily builds relationships with outgoing personality
  • High quality work, organized with attention to detail
  • Customer focus
  • MBA or professional health care degree

Regional Account Manager, Specialty Pharmacy Resume Examples & Samples

  • Research and identify sales targets
  • Make cold calls
  • Develop creative solutions to gain profitable business
  • Manage territory T&E and customer related expenses
  • Travel 50% with occasional evening or weekend event participation
  • Good listener
  • Productive with good planning
  • Proficient use of Outlook, Word, Excel and Power Point
  • Business Acumen - Specialty Medication and Therapy Management
  • 4 + years of experience in specialty pharmacy or medical device sales
  • Proven track record of sales success
  • Multiple Sclerosis, Autoimmune or Oncology therapy sales experience

Assoc Director National Accounts Specialty Pharmacy Resume Examples & Samples

  • Is responsible for complete business ownership of assigned essential Key Accounts; develops Account strategy and objectives in line with MC objectives; aligns Account strategy with other key Sales, Marketing, Medical and Managed Care functions and ensures cross-functional support
  • Leads negotiations, contracting, pull-through and distribution management with assigned Accounts
  • Delivers the Account plans and required financial results for own Accounts; works effectively with colleagues in other functions to achieve Account sales. Liaison with Specialty Products’ Brand and Sales Team
  • The position requires a strong working knowledge of both the practice and business of specialty pharmacy
  • Collaborate with Product BU to develop and utilize the correct programs for each situation
  • Communicate reimbursement and payor issues affecting Specialty Products in accordance with company policies
  • 5+ years of account management experience with managed care, specialty pharmacy, institutional accounts experience
  • 5+ years of managed care contracting experience

Specialty Pharmacy Inside Sales Associate Resume Examples & Samples

  • Build relationships with physician’s offices that deal with complex chronic diseases such as Cancer, Hepatitis C, MS, Rheumatoid Arthritis, and Crohns Disease
  • Within your assigned territory, use effective communication via phone, email, fax, and WebEx, to consistently move customers or prospects toward commitment of using BriovaRx as their specialty pharmacy
  • Work closely with Manager and Director of Sales to determine best plan of action for top accounts in your territory
  • Establish relationships with pharmaceutical manufacturer reps in your territory
  • Utilize territory pipeline and all BriovaRx sales/marketing tools, territory data/reports to successfully grow your book of business and achieve stated goals
  • Uphold the highest ethical standards, comply with all UHG and government policies and regulations
  • Demonstrated success in identifying problems and proposing solutions for clients or customers
  • Proven track record of success against quotas or performance goals in a prior role
  • 1+ year’s sales experience with documented success
  • Experience with cold calling via phone or in-person
  • Professional phone presence with exceptional verbal communication skills
  • Ability to build trust and relationships over the phone
  • Enthusiastic, agile learner, driven to succeed

Senior Product Manager, Specialty Pharmacy Resume Examples & Samples

  • Business owner for therapeutic categories and leader of cross-functional work groups
  • Lead cross-functional work groups to identify and execute strategic enhancements for multiple therapeutic categories
  • Monitors business, P&L, gross margin, EBIT, market share and growth forecasts
  • Extensive data analysis to monitor and drive the business
  • Evaluates the service model and optimizes patient experience
  • Manages work plans for project execution and implementation
  • Responsible for all stakeholders as it relates to product development and programs at the specialty pharmacy (payer, patient, physician, Pharma)
  • Works with Clinical team, Pharma Account Management & contracting teams to develop new programs, revenues, and build relationships with key pharmaceutical manufacturers
  • Leads Therapeutic Resource Center (TRC) Workgroups with Operations, Pharma Acct. Mgmt. and other key partners
  • Develops marketing campaigns and tools for key segments (patient communications, physician communications, web, search engine marketing, etc
  • Bachelor’s degree in related field or equivalent work experience; Master’s degree preferred
  • 8-12 years of relevant work experience or Master’s degree with 5-10 years of experience
  • Excellent communication skills, including presentations and documentation
  • Data analysis and reporting skills
  • Basic financial analysis skills
  • Demonstrated ability to prioritize and manage work load and meet project deadlines
  • Ability to work towards specific deliverables within a environments of tight deadlines and significant pressure
  • Ability to handle complex analysis from issue identification to proposal of potential solutions
  • Excellent customer service skills required
  • LI-AL1

Regional Account Manager, Specialty Pharmacy Resume Examples & Samples

  • 4-5 years’ experience in pharmaceutical sales, or specialty pharmacy sales required
  • College degree, MBA or professional health care degree
  • Fertility, RSV, Growth Hormone, or Hepatitis C sales experience

Specialty Pharmacy It-lead System Analyst Resume Examples & Samples

  • Serve as the liaison between business and systems analysts, developers and project management groups
  • Develop strategies to improve service development life cycle and governance processes
  • Develop detailed source-to-target data mapping and data transformation rules
  • Develop and use enterprise service and data models
  • Responsible for supporting new development and enhancements of the ScriptMed pharmacy system
  • Bachelor’s degree in Math, Statistics or Computer Science, or High School Diploma / GED with 5 years in the IT field
  • 5+ years of experience in Systems Analysis or IT Development
  • 5+ years of experience in all phases of Software Development Life Cycle (SDLC) / System Development Life Cycle
  • 5+ years of experience translating business requirements into a detailed system specification
  • Proficiency with MS Project, Word, Excel, Visio, PowerPoint
  • 2+ years of Relational Database or SQL Experience
  • Must be able to manipulate large sets of data
  • Experience with advanced relational databases and query tools
  • Possess strong analytical, organizational, presentation and problem solving skills
  • Proficient in report writing and query skills such as SAS, and various word processing, spreadsheet, graphics, and database programs including Microsoft Word, Excel, Access, PowerPoint, Outlook, Visio etc
  • Health care experience
  • Experience working with test plans and test cases
  • Experience facilitating Joint Application Design (JAD) sessions
  • Experience working in an Agile environment or familiarity with Agile methodology
  • Specialty Pharmacy or other Pharmacy experience

RN Case Manager, Specialty Pharmacy Resume Examples & Samples

  • Making outbound calls to assess members' current health status
  • Identifying gaps or barriers in treatment plans
  • Providing patient education to assist with self-management
  • Educating members on disease processes
  • Encouraging members to make healthy lifestyle changes
  • Documenting and tracking findings
  • Making calls to patients to ensure understanding of disease state, prescribed medication regimen, and how to manage current disease state and treatment protocol
  • Reviewing medical records for documentation in order to qualify for prescribed treatments
  • Educating and supporting the individual through telephonic assessment and expert clinical case management interventions
  • Active, unrestricted RN license in the state of Texas, and the ability to gain licensure in other states as requested
  • 3+ years of clinical nursing experience with adults
  • Intermediate / proficient level of experience with MS Office applications
  • BSN
  • Experience in managed care, case management and / or disease management
  • Experience working with patients in the following settings and/or patients affected by any of the following disease states: Emergency Department, G.I., Oncology, Multiple Sclerosis, Auto-Immune Disorders
  • Knowledge of disease processes for chronic illnesses in the adult population
  • Experience with Prior Authorizations and/or Appeals

Humana Specialty Pharmacy Customer Care Specialist Resume Examples & Samples

  • Proficiency with a computer including Microsoft Office Programs
  • Must be available to work any shift from 8:00 am - 8:00 pm Monday- Friday and 8:00 am - 6:00 pm on Saturdays
  • Excellent written and verbal communication
  • At least one year of customer service experience

Specialty Pharmacy Representative Resume Examples & Samples

  • Present therapeutic products and creatively teach people about their usage
  • Build trust and credibility and become a true collaborator in commercial success
  • Strong sales and relationship building skills
  • Proven business acumen and a working knowledge of applied science
  • Ability to travel and possess a valid driver's license to drive toassigned healthcare accounts, unless otherwise specified

De-specialty Pharmacy Representative Resume Examples & Samples

  • Call on Infectious Disease and GI physicians to advocate the usage of our client's specialty pharmacy
  • Maximize new business opportunities with physicians and other health service providers
  • A relevant bachelor's degree, ideally in a life sciences field
  • The drive for self-development, the ability to collaborate and an action-oriented work ethic

Specialty Pharmacy Patient Business Associate Resume Examples & Samples

  • Obtain detailed insurance benefit information including but not limited to; appropriate billing information (medical vs prescription covered benefit) retail and mail order prescription co-pays, network pharmacies, plan formulary, prior authorization requirements, and other necessary information to successfully adjudicate a specialty medication claim
  • Evaluate patients medication, insurance, and financial situation and counsel them regarding their prescription insurance coverage, benefits, and related requirements, as well as the resources available through various channels (insurance, drug manufacturers, charity care, etc) to ensure affordable access to specialty medications
  • Ability to train, share knowledge and expertise with colleagues, and develop and implement process improvements
  • Evaluate medication orders to determine appropriate interventions, including prior authorizations, appeals and financial assistance
  • Assist patients with the necessary documentation needed to apply for extra help, charity care, manufacturer drug assistance, Medicaid, and/or other qualifying insurance or assistance programs. Maintain regular contact with patients to ensure smooth and timely transition into these programs, with minimal to no interruption in therapy
  • Proactively monitor patients insurance for changes in benefits and coverage, update billing information in appropriate systems when necessary, and maintain consistent communication with the patient as needed
  • Contact patients with outstanding pharmacy balances and facilitate payment arrangements
  • Document all patient interactions in appropriate systems and databases, including MiChart, TheraDoc, Otis and QS1
  • Stay abreast of current regulations and requirements of insurance companies, assistance programs and other medication resources
  • Act as a resource and effectively communicate complex insurance and financial information associated with specialty medications to all areas within the medical center including clinics and providers as well as insurance companies, patients, and their families. Participate in patient education programs, including group classes and one on one teaching
  • Facilitate patient enrollment or transition to a non-UMHS pharmacy when needed based on patients? insurance requirements to ensure uninterrupted access to their specialty medication
  • Candidates should have an associate degree in a healthcare-related field and/or experience in a pharmacy or medical office setting with strong background in insurance benefits, billing and verification, and patient financial counseling. Candidates with an equivalent combination of 3-5 years of education and/or experience may be considered
  • Bachelor's degree is preferred

Manager, Specialty Pharmacy Ops Resume Examples & Samples

  • 3+ years experience supervising staff
  • Experience working as part of a collaborative team
  • 2+ years in operational management
  • ETASU and REMS experience
  • Experience working with multiple departments
  • 2+ years experience with process improvements
  • Experience managing other pharmacy staff

Pharmacist, Specialty Pharmacy Resume Examples & Samples

  • Supports inherent leadership and supervisory role for technicians and non - clinical employees
  • Performs Clinical review of prescription orders for basic appropriateness of therapy or plan specific criteria review i.e., Prior Authorization
  • Verifies patient orders for completeness and accuracy before being sent to fulfillment i.e., prospective DUR including allergies, interactions, contraindications, etc
  • Counsels patients according to OBRA 90 standards and answers patient questions about medications
  • Accepts physician calls for new prescriptions or questions about our services or Specialty medications
  • Effectively utilizes clinical tools
  • Transfers prescriptions in and out and to other pharmacies as appropriate
  • Supervises and educates pharmacy technicians ensuring Continuous Quality Improvement
  • Maintains applicable pharmacist licensure(s) including necessary Continuing Education requirements, without lapse (any lapse excludes pharmacist from practicing pharmacy)
  • Current, unrestricted Pharmacist license in the state of Florida
  • Minimum 1 year of specialty, community, retail, hospital, or long term care pharmacy experience
  • Presentation, facilitation and / or training experience

Data Manager, Specialty Pharmacy Resume Examples & Samples

  • Gather, consolidate and track all Patient Hub, Specialty Pharmacy, Prescriber, Plan, Payer data. Validate that data being reported and analyzed is of high quality before being delivered to various internal teams
  • Define & maintain data governance and reporting standards with data aggregator, Specialty Pharmacy and Hub service providers to ensure meaningful and standard set of data feed codes
  • Manage the data intake from various data vendors to the Valeant internal reporting platforms
  • Establish SOPs for how to collect, store, and analyze data, especially how to evaluate data completeness, timeliness and accuracy with suppliers
  • Partner with internal teams to develop reporting templates and metrics to track and measure key performance indicators
  • Responsible for creating business reviews documents & management reports to ensure services provided by accounts are consistent with terms of agreements
  • Work with Specialty Pharmacy Account Management, Field Reimbursement Team and other intenal teams to ensure understanding of the data
  • Provide insights on the patient journey & throughput bottlenecks across Hub and Specialty Pharmacies
  • Ensure compliance with regulatory rules including HIPAA policies across 3rd parties

Specialty Pharmacy Sales Account Executive Resume Examples & Samples

  • Submit paperwork and perform administrative tasks in a timely manner
  • Partner with Marketing to design educational tools and presentations for a variety of audiences (i.e. patients, physicians,)
  • Advanced presentation skills to a variety of audiences (size, education levels, roles and responsibilities)
  • Advanced computer skills in MS Word, Excel, PowerPoint and Outlook
  • Ability to travel extensively (up to 80%) throughout Nevada and New Mexico
  • Demonstrated proficiency in consultative skills when addressing complex inquiries from physicians, teammates, vendors, and customers
  • Valid driver’s license in state of employment; driving record must meet insurance liability

RN Supervisor of Case Management Specialty Pharmacy Resume Examples & Samples

  • Supervises their assigned staff in all aspects of the position, including, but not limited to, monitoring of workload, quality assurance, staffing, work assignments, management reports, maintaining account profiles and training
  • Manages each case manager productivity, team work, and revenue on a daily / weekly / monthly basis and as needed
  • Trains new staff
  • Assures their assigned staff are following procedures per account protocols and departmental policy and procedures and meeting all time frames required
  • Assists their assigned staff with difficult cases and provides direction with strategy as needed
  • Performs reviews with their assigned staff every 30 days or sooner if needed
  • Works directly with the leaders of specialty pharmacy
  • Reviews their assigned staff’s clinical documentation to assure quality of work performed
  • Performs ongoing formal and informal reviews of staff and communicates goals, progression and areas for improvement with staff
  • Assures adherence to statutory regulations, HIPAA compliance and department policy and procedures
  • Trains and educates staff continually regarding work assignments, new program or existing program changes, and changes in policies, procedures and laws etc
  • Performs other activities as directed by the Director or Case Management Manager
  • Must have a valid unrestricted RN license and be able to obtain licenses in additional states as requested
  • Excellent communication, organizational and computer skills
  • Prior supervisory experience or demonstrated leadership skills
  • Call center or telephonic nursing experience
  • Bachelor’s Degree relevant to area of responsibility or closely related field
  • Demonstrates the ability to meet people comfortably, and build rapport conducive to effective work relationships
  • Is appropriately outgoing and assertive
  • Understands the agendas and perspectives of others; recognizes and effectively balances the interests and needs of one’s own group with those of the broader organization
  • Demonstrates self-assurance in own ideas, judgment and capabilities
  • Develops and implements cost saving measures; contributes to profits and revenue
  • Looks for ways to improve and promote quality; demonstrates accuracy and thoroughness
  • Coordinates own work efforts; understands and applies procedures, practices and department standards
  • Manages time effectively; handles multiple demands and competing priorities
  • Ability to multi-task; responds and reacts to a variety of critical issues simultaneously

Specialty Pharmacy Home Delivery Resume Examples & Samples

  • Manage a team of Specialty Pharmacists creating a culture of highly engaged Specialty Pharmacy employees
  • Provide clinical leadership for the Pharmacist team
  • Collaborate with our team of nurses to support the clinical needs of our customers
  • Drive process improvements to increase the clinical value that we provide to our customers and to the health professional community
  • Support strategic initiatives to drive improved service, growth, health improvement, and other strategies as defined
  • Licensed Pharmacist active with no restrictions
  • 1+ years of management/leadership experience required
  • Pharmacy Benefit Management (PBM) experience preferred
  • Excellent communication, interpersonal and negotiation skills
  • Proven abilities in conflict resolution, coaching, developing, organization, prioritizing and problem solving are also essential to this position
  • Proficient in basic computer skills
  • Ability to adapt and be flexible within a fast and dynamic environment

Manager, Local Specialty Pharmacy Resume Examples & Samples

  • Ensures that store personnel provide hospitable service and information; and are courteous, friendly, and efficient
  • Responds to customer inquiries and complaints, maintains and improves overall image of pharmacy department. Responds to special needs of customers, as requested
  • BS in Pharmacy or Pharm D Degree from an accredited educational institute, and at least three years directly supervising pharmacy operations
  • Current pharmacist license in the states within the district (or willing to obtain within 1 year) per district guidelines. Must maintain active license
  • At least 4 years of experience planning, developing, and managing departmental expense and capital budgets
  • At least 3 years of experience directly managing people, including hiring, developing, motivating, and directing people as they work
  • Experience with client resolution and exposure to Specialty Pharmacy
  • Experience supervising or staffing of local specialty pharmacies

Specialty Pharmacy Inside Sales Associate Resume Examples & Samples

  • Associate's Degree (or higher)
  • The ability to create, save, and edit in Microsoft Word
  • 1+ year of sales experience with documented success

Associate Director National Accounts Specialty Pharmacy Resume Examples & Samples

  • 7-10 years of experience in the pharmaceutical/healthcare industry
  • 5+ years of account management experience with managed care, specialty pharmacy, and institutional accounts experience
  • 5+ years working with specialty product related medical practice, insurance and managed care, pharmacy practice, competitive business practices, competitive product knowledge, as well as commercial and government payer reimbursement issues

Marketing Intern BB Specialty Pharmacy Team Resume Examples & Samples

  • Supporting the development of a metric-based marketing plan
  • Building exclusive sales materials that deliver on a surround-sound marketing plan
  • Partnering with Sales Ops and Training to develop appropriate training tools
  • Influencing and building consensus with peers and business partners

Account Executive, Specialty Pharmacy Resume Examples & Samples

  • Attend team meetings, phone conferences, and training as needed
  • Utilize multiple technology platforms to manage accounts
  • Follow expense guidelines and budgets
  • Work with cross-functional teammates to build the right service and fulfillment model
  • Maintain current knowledge of DaVita Rx Pharmacy services and benefits
  • High Contribution to the rest of the account management Team through sharing successes and BDPs, Innovating, and Utilizing Creativity to drive unique business solutions
  • Dedication, above all, to caring for patients suffering from chronic disease across the nation
  • A minimum of 3 years prior Sales experience with Physicians that specifically provide Oncology, Gastroenterology, Rheumatology, Hematology or Neurology care as primary customer, prefer 5 plus years
  • A proven record of consistently Exceeding Sales Quotas
  • Professional presence and excellent presentation skills
  • Strong analytical proficiency in Excel, PowerPoint required
  • Strong written, verbal, and interpersonal communications skills including ability to listen attentively and to communicate information clearly and effectively
  • Ability to travel extensively (up to 80%) throughout the Los Angeles area and intermittently to Los Vegas, Albuquerque and to corporate functions
  • Commitment to DaVita’s values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, teammates, management, physicians and others in everyday performance and interactions
  • Demonstrated salesmanship ability and ability to influence others
  • Exceptional client relationship management and people skills

Clinical Program Manager Specialty Pharmacy Informatics Resume Examples & Samples

  • Maintain and update the Specialty Pharmacy Classification Policies
  • Provide guidance, decisions and execution on specialty drug list decisions for Argus process including weekly FDB/Medispan clinical oversight and decisions
  • Provide guidance, decisions and support to the clinical operations team on specialty drug catalogue decisions during the Codeset meetings and submits Specialty Pharmacy Codeset change ticket requests
  • Provide guidance and maintain all specialty drug lists (impacting the pharmacy and medical benefits) including utilization management (UM), Specialty/Optional/Medical lists, Exclusive SRx Home Delivery, clinical edits, business and client reporting, URAC compliance, Therapy Management, HealthEview, RxSavings Messenger and other customer decision tools
  • Identify lists and processes that could be migrated to the drug catalogue process, drive prioritization, and manage these lists during decision and migration timeframes
  • Assure consistency of drug list designs across medical and pharmacy benefits and claim engines
  • Develop and implement process to document and archive all Specialty Drug list decisions
  • Assists in establishing affordability and health improvement goals at a condition/therapeutic class level within Integrated Clinical Scorecard, KPI’s and long term business plan
  • Provide guidance to clinical program manager team members and Informatics team on identification of drug codes and other relevant clinical information for analytical purposes
  • Participate as a subject matter expert in the Therapeutic Class Strategy process, including design and decisions related to Utilization Management, Therapy Management, and Specialty fulfillment
  • Serve as client facing specialty pharmacy clinical expert as needed by Go To Market team, including client and RFP/RFI comparisons of drug lists, UM, and clinical programs across pharmacy and medical benefits
  • Primary liaison and subject matter expert with clinical operations, Pharmacy Criteria Council, and Pharmacy Service Center operations teams
  • Develops and maintains appropriate specialty pharmacy clinical program design and results documentation for internal and external use
  • Co-develop policy and procedures that govern clinical program operation
  • Bachelor’s degree in Pharmacy required; PharmD preferred
  • Intermediate knowledge of Microsoft Office applications including Excel and Access and preferable SQL coding capabilities required
  • 5+ years of experience in Specialty Pharmacy with a Pharmacy Benefit Manager (PBM) or health plan required
  • Strong knowledge of PBM, Specialty Pharmacy and Health Plan business model required
  • Strong knowledge of drug coding standards and medical claims (HCPC) coding standards required
  • Proven capabilities in operational execution and decision making
  • Proven program implementation and oversight skills
  • Demonstrated ability to work in a highly matrixed environment
  • Creative thinker with strong organization and planning skills
  • Positive and team-oriented attitude and approach to getting work done
  • Proven ability to execute in fast paced, complex environment

Specialty Pharmacy Strategic Clinical Program Manager Resume Examples & Samples

  • Therapeutic class reviews of all specialty medications, holistic financial and clinical integration reporting
  • Development of patient and physician outreach programs to ensure appropriate use, compliance, and outcomes
  • Identification and review of Pipeline medications, proactive strategies to address formulary positioning and rebate opportunities
  • Liaison between Contracting team and Specialty Pharmaceutical Manufacturers, evaluation of traditional and value based rebate opportunities
  • Integration into and representation at Enterprise Specialty Strategy Team, responsible for launching corporate wide direction within the Medicare Business
  • Channel optimization related to filling of Specialty Medications
  • Physician liaison and Specialty subject matter expert, participation in integrated benefit design
  • Ability to evaluate emerging industry trends and benchmark against internal results
  • Establishes practical, executable, measurable, and financially viable plans of enhance the profitability and accuracy of the Part D product
  • Utilizes financial economic expertise to calculate program ROIs
  • Bachelor’s degree in Pharmacy required; PharmD highly preferred
  • Extensive Medicare knowledge, with specific acumen in Medicare Part D, highly desired
  • Minimum 5 year’s experience in the healthcare industry, health plan or pharmacy benefit management (PBM) highly preferred
  • Minimum 5 years experience working with/in analytics. Ability to mine and analyze extremely large data sets of pharmacy claims
  • Proficiency with MS Excel and Access required
  • Demonstrated ability to work in a highly matrixed environment, high degree of emotional intelligence and interpersonal savvy. Self-starter and ability to work independently and autonomously
  • Strong presentation skills, written/verbal proficiency
  • Ownership of Specialty Pharmacy Strategy or benefit administration
  • Current or previous people leadership experience
  • Valuation of large scale Strategic Initiatives
  • Experience building tools and automated solutions
  • Ability to expertly utilize SAS for data mining

Specialty Pharmacy Liaison Resume Examples & Samples

  • Lead and facilitate daily conference calls with specialty pharmacy contacts (and client, if applicable) to monitor patient progress, reconcile data discrepancies, research missing data, handle inquiries and provide updates as requested
  • Coordinate and process copay requests including but not limited to patient status requests, copay assistance, prior authorization and billing inquiries and obstacles, eligibility inquiries, and claims processing challenges
  • Create and maintain action log, agendas and minutes for each specialty pharmacy meeting
  • Handle inbound/outbound calls from all applicable customers including but not limited to specialty pharmacy contacts, client contacts, third party vendors and internal team resources
  • Triage and/or approve referrals to specialty pharmacies daily or as needed
  • Reference and implement Business Requirements Document (BRD) as it pertains to operating procedures, validation of incoming data from the Specialty Pharmacy, and identifying and escalating data feed issues internally and externally
  • Identify needed system enhancements and/or reports and participate in requirement review, testing and implementation
  • Implement business requirements for newly-contracted specialty pharmacies joining the network to ensure adherence to all contractual obligations; ensure all data is validated prior to program launch
  • Coordinate data transfer with client and ensure data integration during transition of product support services from another HUB provider
  • Share best practices and learning opportunities with reimbursement team
  • Identify and report Adverse Events
  • Strong negotiating skills
  • Strong mathematical skills
  • Strong organizational and time management skills; keen attention to detail
  • Ability to work independently, within a team environment
  • General knowledge of reimbursement principles, pharmacy operations and medical claims
  • General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred
  • Global understanding of commercial and government payers preferred
  • Demonstrated proficiency with Microsoft Excel (intermediate level), Outlook and Word

Director, Specialty Pharmacy Solutions Resume Examples & Samples

  • Implements SP specific segment strategic and tactical sales plans to support corporate goals; utilizes the AmerisourceBergen consultative sales approach of uncovering customer business needs and creating ABC solutions to fit those needs
  • Manages assigned key SP segment accounts to deliver the targeted Gross Profit to ABDC, as well as an excellent customer experience
  • Drives new business with targeted SP segment large/national prospects and consults with the CSP National New Business and District Teams on High Value and Small targeted prospects/opportunities
  • Implements and executes the assigned SP segment specific GPO value proposition and sales strategy; ensures the CSP National New Business and District teams are fully informed
  • Builds and manages relationships with both the CSP National New Business and District sales teams; as well as ensuring strong and productive ongoing relationships with key ABDC functional leadership
  • Consults with assigned and CSP District team SP customers to create profitable business strategies taking into account such factors as customer’s vision and goals, current results by category/program and compliance with ABC programs and services
  • Develops and implements strategic/tactical sales and marketing plans to accommodate ABDC business goals within assigned SP segment accounts
  • Determines and executes the SP account specific value proposition and sales strategy; identifies resources; operates as the single point of contact in new strategic opportunities
  • Gathers information, analyzes and develops strategies concerning dynamics that may affect area of responsibility, such as changes in customer ownership, new affiliations, current market share and targets of opportunities for new growth, customers’ changing requirements, competitor strengths and weaknesses, and continually communicates these strategies internally using updates to written business plans and ongoing business communication
  • Requires broad training in fields such as business administration, accountancy, finance, sales, marketing, or similar vocations generally obtained through completion of a four year bachelor’s degree program or equivalent combination of work experience
  • Normally requires a minimum of six (6) years directly related and progressively responsible experience
  • Specialty pharmacy sales experience highly preferred
  • Strong consultative selling skills
  • Experience at building and executing strategic account penetration plans
  • Orchestrates organizational resources
  • Excellent Organizational & Project Management skills
  • Demonstrated value-based sales record
  • Working knowledge of pharmaceutical distribution with emphasis in specific Specialty Pharmacy segment sales and healthcare trends
  • Working knowledge of sales management, sales planning and goal setting, successful strategic and consultative selling techniques, and related information
  • Ability to lead large, value-driven pursuits
  • Strong leadership skills

Specialty Pharmacy Liaison Resume Examples & Samples

  • Excellent active listening and written/verbal communication skills required to
  • Quickly and accurately understand the need of callers seeking information
  • Provide responses that address the specific needs of each caller, while complying to Alkermes program and compliance guidelines
  • Document call details with attention to data integrity for analysis supporting business objectives
  • Ability to multi task, problem solve and work independently
  • Effectively plan, prioritize, execute, follow up and anticipate problems
  • Manage multiple projects in fast-paced, deadline driven environment
  • Work collaboratively across multiple stakeholder groups
  • Prior reimbursement experience with ability to communicate complex reimbursement scenarios and solutions to patients and medical professionals
  • Demonstrated ability to work collaboratively in a team environment and as an independent contributor
  • Ability to think critically and problem solve to address customer needs and barriers to product fulfillment
  • Ability to support programs needs as necessary
  • Accommodate approximately 15% overnight travel for
  • Bachelor’s degree preferred
  • Minimum of 3 years’ experience working in a reimbursement hub supporting products distributed by a specialty pharmacy, time working in specialty pharmacy operations, or for an aggregator of specialty pharmacy data
  • Experience implementing and supporting electronic data exchanges between a reimbursement hub program, and specialty pharmacy
  • Knowledge of health plan reimbursement requirements for specialty injectable products covered by both medical (AOB) and pharmacy benefits
  • Working knowledge of the compliance and regulatory environment for manufacturers in the pharmaceutical space
  • Experience and understanding the importance of reimbursement hub metrics and operations in the pharmaceutical industry
  • Proficiency in Microsoft Outlook, Word, Excel, and Power Point
  • Program /product launch experience a plus

Manager, Specialty Pharmacy Resume Examples & Samples

  • Supervises the activities of pharmacists and support staff assigned to the store; ensures accurate and timely preparation and processing of orders and computer operations
  • Assumes responsibility for safe and accurate handling of all funds and records
  • Reviews and interprets all physicians orders for processing, rationality, dosage form, allergies, interactions, incompatibilities, etc.; advises prescribing physician of inconsistencies and recommends alternate medications; determines proper quantities to be prepared/dispensed
  • Provides drug information to physicians, nurses, patients, and other appropriate individuals by consulting with physicians regarding any and all drug therapy requested; clarifies physician orders and assists physicians in investigating new and alternate medications to be used; performs drug information research as needed; participates in drug studies and research
  • Instructs patients regarding individual mediation therapy
  • Enters patient and medication order information into pharmacy computers to facilitate medication dispensing, and utilizing computer as a drug information resource
  • Coordinates the third-party prescription process by ensuring accuracy of information to include patient name, physician provider numbers, product name or NDC number, directions, directed daily usage and corresponding quantities
  • Supervises personnel functions and analyzes work flow and adjusts scheduling as needed
  • For specialty pharmacy: develops clinical documentation standards as required by URAC and other internal and external regulatory groups and customers
  • Develops integrated team and individual goals tied to overall specialty pharmacy goals
  • Adheres to direct report payroll budget and other budget areas defined by Senior Director
  • MS Residency may substitute for required experience

Specialty Pharmacy Liaison Resume Examples & Samples

  • Provide consistent and effective
  • Bachelor’s Degree and
  • 0-2 years of experience or 6-8 years relevant working experience
  • 2 years experience in
  • Proficient in
  • Ability to handle a
  • Advanced problem
  • Strong attention to
  • Research, analysis,
  • Demonstrated customer

Assistant Manager, Specialty Pharmacy Resume Examples & Samples

  • Ensures adequate staffing of these areas
  • Reviews daily, monthly and other periodic management reports to monitor service levels
  • Plans, develops, and manages all policies and processes related to technical pharmacy operations
  • Provides Manager with timely feedback regarding operational issues to ensure efficient workflow

Specialty Pharmacy Program Manager Resume Examples & Samples

  • Responsible for the management and growth of current products and ensure timely reviews, updates, and enhancement of existing programs
  • Evaluate complex medical information related to specialty pharmaceuticals and work with internal partners around program requirements, consultation, and feedback related to specialty management
  • Assist in the creation and execution of product plans to meet growth initiatives, identification of new product enhancements, operationalizing, and measuring specialty programs and management of relationships with strategic partners and key internal stakeholders
  • Bachelor’s degree and minimum of 8 years work-related experience, or
  • Master’s degree and minimum of 6 years work-related experience, or
  • 10 years of equivalent work-related experience

Specialty Pharmacy Program Manager Resume Examples & Samples

  • Responsible for the coordination and completion of projects across various functional areas. Typically, employees in this function are working towards or have achieved certification in project management
  • Makes presentations to management on project updates, project cycle, and expected results. Ensures projects are completed on time and in scope
  • May manage vendor and service providers to define project scope and performance expectations. Incumbents maybe part of a project management office (PMO) in their business
  • Project Management roles specific to a particular functional area should be assigned to that family where appropriate (e.g. IT Project Managers should be placed in the IT Family)
  • Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.Analyzes and investigates
  • Bachelor Degree (or higher) in Accounting, Finance, Business or related field or HS Diploma/GED with 4+ years of professional Project Management experience
  • 2+ years of project management experience
  • 2+ years’ experience in tracking, planning projects, working with large data sets and making data-driven analytical decisions
  • Ability to communicate ideas clearly and concisely
  • Ability to prioritize and balance multiple priorities and projects

Specialty Pharmacy Services Resume Examples & Samples

  • Provide ongoing performance updates throughout the year
  • Counsel and administer disciplinary action in accordance to department and Human Resource policies
  • Address questions and concerns from the team
  • Provide individual and department training,mentoring and motivation to support and improve performance

Specialty Pharmacy Liaison Resume Examples & Samples

  • Bachelor’s Degree and 0-2 years of
  • 2 years experience in a customer
  • Ability to handle a fast paced
  • Strong team building skills and
  • Research, analysis, report
  • Demonstrated customer service

Specialty Pharmacy Liasion Resume Examples & Samples

  • Provide consistent and effective communication to all appropriate stakeholders as first line support/single point of contact with contracted specialty pharmacies to identify and escalate issues and cases
  • Responsible for analyzing incoming data and recognizing trends and cases that need further action. Ensure all contractual timeframes related to SP data review are successfully met, if applicable
  • Lead weekly (more or less frequently as needed) calls with each contracted SP to review patient statuses to include those at risk of lapsing in therapy, shipment and/or insurance delays, missing shipment and updates as applicable. Provide timely tracking of receipt of referral, status of contracted SP activity, and potential interruptions in therapy
  • Gathers, analyzes, and prepares data, including Adverse Event trending, for Quarterly Business Reviews (QBRs), FDA requirements, and other special projects and reports as applicable
  • Bachelor’s Degree and 0-2 years of experience or 6-8 years relevant working experience
  • 2 years experience in a customer service setting, preferably in a call center environment
  • Previous experience in the PBM and/or healthcare industry preferred
  • Demonstrated team lead experience preferred
  • Advanced problem solving and trouble-shooting skills
  • Strong team building skills and the ability to train other team members
  • Research, analysis, report preparation and documentation skills

Manager, Local Specialty Pharmacy Resume Examples & Samples

  • Ensures that store personnel provide hospitable service and information, and are courteous, friendly, and efficient
  • BS in Pharmacy or PharmD Degree from an accredited educational institution
  • Current pharmacist license in the state where the site is located or willing to obtain by position start date. Must maintain active license
  • At least 2 years of experience in indirect management of team members, including assisting in the development, training and assignment of work/projects to other team members, or completion of a residency
  • At least 2 years of experience planning, developing, and managing departmental expense and capital budgets
  • At least 2 years of experience directly managing people, including hiring, developing, motivating and directing people as they work

Specialty Pharmacy Coordinator Resume Examples & Samples

  • Work with healthcare providers and patients to assist with appeal management for claim
  • 2+ years medical or insurance industry experience
  • 5 years experience in the healthcare industry including, but not limited to, Medicare and/or Medicaid program administration, insurance verification and/or claim adjudication, physician’s office or outpatient billing, pharmacy and/or pharmaceutical manufacturers
  • Must be able to analyze reimbursement specific data and prepare written reports for management and client communications
  • Strong problem solving and decision making skills
  • Ability to effectively handle multiple priorities within a changing environment
  • Proficient with MS Office (Strong Excel skills preferred)
  • Proficient with MS Outlook
  • ICD-10, HCPCS, CPT experience

Specialty Pharmacy Program Senior Manager Resume Examples & Samples

  • Serve as the primary point of contact for the Brand team for programs across all SPs on implementation of contracted programs, including operations and performance management
  • Lead the planning, tracking and implementation of Specialty Pharmacy programs by serving as the business unit liaison with cross functional teams
  • Establish/apply quality objectives, criteria, standards and levels using appropriate quality management methods, with stakeholder input (e.g., key performance indicators, scope definition
  • Specialty Pharmacy, Pharmacy Benefit Management (PBM), or health plan experience
  • Previous Field, Access and Reimbursement experience from a program development, marketing, sales, or operational standpoint
  • Project management experience preferred – ability to track complex projects and bring tasks to completion on time and within budget
  • Process management experience – the ability to document processes and improve them to eliminate waste

Specialty Pharmacy Account Executive Resume Examples & Samples

  • Responsible for managing the pharmacy relationships across key national and regional accounts, often in collaboration with our payer team
  • Serve as the primary point of contact for specialty pharmacy activities including contracting, and implementing fee for service programs including operations and performance management
  • Support the implementation of complex projects spanning across business units where research/analysis requires evaluation of business requirements, development of achievable short/long term objectives, and coordination of interdependent activities to ensure the successful implementation of program initiatives
  • Support program development, value proposition, oversight, and day-to-day management for specialty pharmacy programs include: Pharmacy based patient clinical management programs, Provider programs, Pharma services (Adherence Program, Patient Assistance, Hub Triage, Value Based Contracting, Pharmacy and Medical Benefit Clinical Programs
  • Travel to Specialty Pharmacies to ensure successful implementations
  • Report program performance against expectation and influence changes to programs to improve competitive position and optimize performance
  • Lead or help develop program or project scope statements, in consultation with applicable stakeholders (e.g., Brand Teams, RAV, OCT, GSS, and Legal)
  • Call center / reimbursement hub management experience preferred, call center / reimbursement partner management experience a plus
  • Previous Access and Reimbursement experience from a program development, marketing, sales, or operational standpoint
  • Prior managed health plan, pharmacy benefit and specialty drug management experience preferred
  • Understanding of managed care and pharmacy benefit cost management levers preferred
  • Communication skills – strong spoken and written communication skills to translate Amgen business requirements into operational programs at a partner operation, and ability to effectively navigate to win-win agreements across diverse internal and external partner groups

Director of Specialty Pharmacy Resume Examples & Samples

  • 10+ years of related work experience in biotech/pharmaceutical industry, preferably with some managed markets account management experience
  • Proven track record of developing and maintaining strong relationships with National Health Plans, Managed Care Organizations, Pharmacy Benefit Management companies, channel/specialty pharmacy experience
  • Significant finance and strategic experience across operations, accounting/finance, sales with deep knowledge of pharmaceutical industry and trends
  • Demonstrated excellent financial and analytical skills
  • Experience successfully leading teams, including direct reports to exceed corporate objectives
  • Excellent interpersonal, leadership, and coaching skills to direct reports or in a matrix organization
  • Ability to develop and present comprehensive, enterprise-level strategic plans to exceed corporate objectives of the Sandoz Leadership Team
  • Ability to execute tactics with direct reports or matrix team that supports the corporate objectives of the organization
  • Ability to analyze highly complex, quantitative and qualitative situations and make effective recommendations
  • Strong time management skills with the ability to prioritize activities based on overall value
  • Ability to integrate Company and customer interests in the development of effective proposals
  • High level of business planning and organizations skills
  • In-depth understanding of Managed Markets marketplace as well as benefit design or reimbursement issues and experience with biologics and biosimilars preferred
  • Demonstrated business acumen applied to achieving portfolio priorities
  • Proven track record of developing and maintaining strong relationships with National health plans, GPOs institutional/LTC/Oncology, Specialty Distributors, and Government agencies
  • Field based, thus travel by vehicle (and where necessary airplane) in the assigned territory as directed, promptly and efficiently, meeting at least 50% travel requirements

Specialty Pharmacy Representative Resume Examples & Samples

  • Bachelor’s degree in business, healthcare or related field is required
  • 1 year of sales, account management or hospitality experience is required
  • Basic understanding of MS Office (Word, Excel, PPT) is required
  • 3 years of experience in healthcare, pharmacy or reimbursement is preferred
  • Strong communication and follow-up skills is highly preferred
  • Sense of autonomy and independence is highly preferred

Associate Director of Patient Services Specialty Pharmacy Resume Examples & Samples

  • Executing marketing analyses capturing relevant distribution market dynamics
  • Business case development and distribution-focused strategic planning for Biopharma products and portfolio
  • Collaborate with internal teams to negotiate and implement new distribution strategies
  • Regular interactions with brand teams and other key stakeholders to share analyses and insights
  • Participate in yearly strategic planning and budget exercises

Cigna Specialty Pharmacy Accreditation Lead Resume Examples & Samples

  • Assist in the management of accreditation requirements and work with all appropriate business partners
  • Possess a thorough understanding of CSP’s interpretation of URAC Specialty Pharmacy standards (and other accreditations) in order to be the source of information for Specialty Pharmacy URAC (and other accreditations) compliance questions from within the pharmacy
  • Facilitate and drive the meetings to reassess and evaluate CSP patient management programs as well as work on performance improvement projects for increased service with the patient management programs as part of accreditations
  • Enable CSP to be adequately prepared for any changes to URAC requirements during monitoring visits and reaccreditation surveys by reviewing accreditation standards to ensure the pharmacy continues to remain compliant at all times
  • Participates in and/or facilitates the design, development, and implementation of new operational controls, performance metrics, and automated processes as associated to accreditations
  • Develop, document and maintain analytical reporting in regards to accreditations that are crucial to the Specialty Pharmacy growth
  • Attend communication meetings with other accredited areas of the business to ensure CPS’s interpretation of core standards is consistent with accredited matrix partners and for increased knowledge as CSP SME on accreditation measures
  • Create communications to share at supervisor team meetings and joint team meetings. These should include accreditation compliance reminders, definitions and other information to keep the accreditation fresh in between reaccreditation initiatives
  • Maintain documentation on accreditation reporting standards and ensure all reporting requirements are met as needed
  • Work with Cigna HR department, CSP training and CSP supervisors to ensure employee personnel files meet all accreditation requirements
  • Work with Cigna matrix partners (TheraCare, Medical Billing, Procurement, and Production) across the business to ensure contributions to CSP accreditations remain accurate and consistent
  • Assist Supervisors with internal audits on CSP staff and operations as they relate to accreditation requirements to ensure full compliance and minimize risk during monitoring visits and reaccreditation surveys
  • Coordinate CSP policy and procedure (P&P) review and updates in conjunction with policy owners and national P&P committee
  • Update CSP URAC Cigna University training with new standards and information as needed
  • Provide required URAC new hire and annual training and work with Cigna U to continually update training materials
  • Monitor certification, licensing and registrations to ensure no lapses occur that could result in risk for obtaining or renewing accreditations that are key to CSP growth
  • Be responsible for working with matrix partners to obtain the appropriate evidence as proof of compliance with Specialty Pharmacy and CORE Standards and provide that evidence for URAC Desktop Review
  • Coordinate closely with the CPM Quality Assurance area in providing documentation as required for CPM/UM and Specialty Core URAC standards
  • Key contact for URAC Auditors during On-Site Reviews providing information as requested including policies and procedures, job descriptions, training documentation, and coordinating interviews with key matrix partners
  • Assure that delegated entities are in compliance with URAC standards
  • Coordinate efforts to mitigate any risks as identified in Corrective Action Plans
  • 3+ years of business experience in auditing and reporting required; compliance and URAC auditing background highly preferred
  • Specialty Pharmacy business knowledge required
  • Proficiency of Microsoft Word, Excel, and Power Point required
  • Experience in facilitating training content for knowledge transfer; excellent presentation skills required
  • Demonstrated ability to drive results required
  • Strong analytical and problem-solving skills required
  • Extremely detail oriented, with proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards) required
  • Ability to establish and maintain effective professional working relationships with senior leaders, managers and employees, along with working with external clients/vendors
  • Act with a sense of urgency to research questions or issues brought by the team
  • Proven ability to act independently and decisively, with minimal supervision
  • Experience with continuous quality improvement methods and tools, such as Six Sigma, preferred
  • Ability to create and implement contingency plans and solutions for problems that arise preferred

Specialty Pharmacy Program Manager Resume Examples & Samples

  • Liaison with the SP Customer Facing Team to gather insights from SPs, deploy programs, and monitor contract performance and quality
  • Support access team with creation of specialty pharmacy tools required for pharmacy use or for internal training, or HCP/patient use
  • Lead or help develop program or project scope statements including SOW/ contract langauge, in consultation with applicable stakeholders (e.g., Brand Teams, RAV, OCT, GSS, and Legal)
  • Experience relevant to Products: Enbrel and Repatha, or in respective therapeutic class
  • Analytic experience – Microsoft Excel skills (ability to create and troubleshoot calculations), attention to detail
  • Ability to work through others and mange in a matrix environment

Specialty Pharmacy Analytics Project Manager Resume Examples & Samples

  • Apply project management methodology during all phases of the project cycle, with responsibilities including project design, scope management, and both quality and performance reporting
  • Organize and lead matrixed teams in the delivery of high-quality programs and solutions that meet business needs
  • Create detailed project design documents and task-level project plans to organize cross-functional teams
  • Partner closely with other members of functional project teams to define business requirements
  • Effectively manage scope, issues and timelines toward meeting defined dates and deliverables
  • Prepare and present project plans, status and updates to management
  • Prepare and present cost-benefit analyses
  • 2-4 years of demonstrated success leading projects, including technology solutions
  • Demonstrated success leading initiatives that deliver well defined solutions
  • Strong influencing skills and demonstrated experience leading matrixed teams
  • Project Management Institute PMP certification

Specialty Pharmacy Liaison Resume Examples & Samples

  • Identification and qualification of patients eligible for medication patient assistance programs and foundations. Interfaces with program administrators for reimbursement assistance programs sponsored by the drug manufacturer. Tracks, documents, and reports out cost savings associated with patient assistance drug recovery programs and provides updates to pharmacy management. Provides manufacturer coupons to patients, if available
  • Assists the pharmacist in all operational activities of the pharmacy in order to optimize customer satisfaction and maximize profitability of the pharmacy. The specific duties would include customer relations, computer and prescription filling, drug orders and inventory, marketing, accounting and any supportive tasks involved with workflow. Responsible for policies and Proceedures (as they pertain to operations, quality assurance, goals and priorities)
  • Customer Service- communicate with patients in a friendly, welcoming manner with greeting provided by management. Completion of updating accurate demographic information such as address, birthdate, insurance information and allergies. Provide appropriate waiting time via telephone or in person. Responsible for finding a patients insurance information if the patient is unable to provide. The "Service for Excellence" mission provided by YNHH is the main focus. Awareness of all of the "non-negotiables" (10/5 rule, no venting, library voices, AIDET and the Pledge to Service of Excellence)
  • Computer and prescription filling- demonstrates proficiency in cross-funtional areas of the department, including (but not limited to) QS/1, Mckesson ordering process, Epic, Therigy, Emdeon, Macro Helix, Employee Self Service and the DSS website. Responsibilities also include awareness of specific programs (MAP, Workers Comp, Columbus House, etc) and how to process prescriptions within these programs. Responsibility for regulatory awareness and reporting of medication errors
  • Drug Orders and Inventory - accumulate information on prescription drugs needed. Place and transmit orders daily into Mckesson. Review reports from Macro Helix and the management of our 340B inventory. Report any discrepencies to management and review weekly for prescriptions not picked up and return to stock every 14 days. Review backordered items to see if another source can be ordered. Review and verify 340B reports
  • 3-5 years of retail pharmacy technician experience, specialty pharmacy technician experience preferred. Experience with direct patient counseling and excellent customer service skills are required

Specialty Pharmacy Patient Care Coordinator Resume Examples & Samples

  • Responsible for providing phone and on-line support for patients, prescribers, insurance companies and retail pharmacies, ensuring a specialty pharmacy patient gets and takes their medicine
  • Responsible for entering the patient information including name, date of birth, insurance information, allergies and medication history into our therapy-specific patient assessment software (TherigySTM)
  • Responsible for maintaining telephone communication with patients, local Publix pharmacies, prescribers, and others in the Central Pharmacy and RBU to ensure quick delivery of the patient’s specialty prescriptions
  • Responsible for monthly follow-up calls to patients to assess compliance with drug therapy, identify any barriers to patient adherence (for example, the patient cannot pick up the medication because it is too expensive or the patient feels like he/she has too many medications to take, or the patient can’t remember to take medications) and facilitate discussions with the Clinical staff to help the patient overcome barriers and process refills. Patient Care Coordinator will process prescriptions within the EnterpriseRx system
  • Responsible for supporting the Intake Department Lead
  • 1 year experience working in a retail, mail order or specialty pharmacy
  • Registered with (or able to be registered with) the State of Florida as a “technician in training”. Must become a state registered technician within 6 months of hire
  • Broad knowledge of retail pharmacy and the healthcare environment and industry
  • Knowledge of multiple pharmacy software systems such as EnterpriseRx, and other software used in pharmacy and healthcare, (such as medical billing software, coding and procedures), Microsoft Office. Medicare billing knowledge is highly valued
  • Knowledge of Specialty Pharmacy Accreditation Standards (i.e. URAC)
  • Knowledge of pharmacy and healthcare laws, rules and operating policies and procedures (ex. HIPAA)
  • Various computer skills
  • Data management and correction skills
  • Ability to communicate effectively and professionally in both written and verbal format
  • Excellent planning, organizational and time management skills; autonomy and self-motivation
  • Flexibility and adaptability skills
  • Analytical skills for independent problem solving
  • Willingness to work a flexible schedule with extended hours
  • Bachelor’s degree (BS or BA) in a healthcare or business related field
  • 2+ years’ experience in a specialty pharmacy, hospital, health insurance company, benefits department or other related healthcare environment
  • Certifications within the specialty pharmacy industry

Specialty Pharmacy Reporting Resume Examples & Samples

  • Drives specialty technology solutions that meet business needs with consideration for time, schedule, and cost
  • Acts as a business project manager to execute / lead projects from project inception through to deployment
  • Takes part in contract reviews, negotiations, and contract edits as related to data obligations. Acts as the subject matter expert in data related matters, including business requirements
  • Develops pharma reporting specifications and requirements
  • Focuses efforts on specialty pharmacy program reporting and data projects required in support of contractual commitments
  • Partners with IT and internal Pharma Reporting development team to identify and execute deliverables based on project scope driven by contractual commitments
  • Represents business interests in technology projects, providing business insight and a single point of contact for business throughout the project lifecycle
  • Creating / updating operational decision and infrastructure support tools including executive dashboards, reports, and templates
  • Supports / coaches other colleagues that are part of the project team to learn and apply skills directly tied to the project lifecycle. Acts as an application subject matter expert, provides guidance to more junior staff on system capabilities and enhancements
  • Will partner with internal personnel to resolve production related issues for end users / clients
  • Use a consultative approach to ensure our internal and external client’s needs are being met; may support colleagues in training or working sessions to support internal / external clients

Cigna Specialty Pharmacy Home Delivery Support Associate Resume Examples & Samples

  • High School Diploma or equivalent required. Some college courses preferred
  • Problem solving skills, attention to detail, and strong communication skills required
  • Ability to achieve current department standards in both quality and productivity is required
  • Strong data entry, typing skills and proficiency in the use of a PC, including use of multiple applications simultaneously required
  • Ability to locate and interpret complex information from approximately multiple computer applications residing in a Windows environment
  • Capacity to work in a production and quality environment to meet required standards
  • Ability to succeed within a team environment
  • Demonstrated high-level communication skills through expressing thoughts and information clearly and succinctly

Specialty Pharmacy Program Specialist Resume Examples & Samples

  • Bachelor’s degree in Healthcare, Finance, English or related area of study required
  • 3 years of experience in pharmacy setting required (5 years preferred)
  • Experience with prior authorizations, copay assistance, conducting benefits investigations in a specialty pharmacy/pharmacy environment strongly preferred
  • Experience with pharmacy accreditation process is strongly preferred
  • Pharmacy Technician Certification is a plus
  • Must be highly organized
  • Must possess strongly written and verbal communication skills
  • Must be a team-player

Specialty Pharmacy Insight Manager Resume Examples & Samples

  • Bachelors required; MBA or Master's degree preferred in Business Administration, Marketing, Economics, Statistics, or other relevant discipline
  • 7+ years’ experience with healthcare and pharmaceutical data strategy
  • 3+ years in the specialty market: preferably experience in managing, cleaning and/or analyzing specialty care data directly from Specialty Pharmacies
  • Expertise in the reimbursement of specialty pharmaceuticals to guide decisions related to medical and pharmacy coverage
  • Experience using SAS, SPSS or other advanced analytic software
  • Experience with launching a brand in healthcare a plus
  • Strong interpersonal skills, demonstrated ability to work collaboratively with peers and strong consulting skills
  • Ability to build credibility and relationships with internal customers

Director Specialty Pharmacy Resume Examples & Samples

  • Doctor of Pharmacy degree from an ACPE accredited School of Pharmacy
  • 5 years experience in a clinical pharmacy management role with demonstrated results
  • Proficiency in computer office applications (Word, Excel, Powerpoint)
  • Familiar with current clinical and therapeutic literature
  • Demonstrates the capability to perform in specialized areas and services
  • Familiar with regulatory standards and guidelines (ie. NPSG, Accrediting Organization, Core Measures)
  • Good interpersonal skills, to deal with a wide variety of individuals
  • Good communication skills to achieve understanding and acceptance
  • Ability to gather data and prepare cost analysis reports
  • Illinois state licensure as a Registered Pharmacist
  • Ability to manage multiple tasks simultaneously and prioritize work to complete urgent tasks preferentially
  • Schedule flexibility to meet the needs of the system, adaptable to changes in workload and/or work schedule
  • Ability to travel to various hospitals
  • Directs the development of Advocate Specialty Pharmacy
  • Directs clinical outcomes of specialty pharmacy services
  • Oversees financial aspects of reporting departments
  • Human Resources

Specialty Pharmacy Service Coordinator Resume Examples & Samples

  • High school diploma or general education degree (GED)
  • One year of pharmacy experience (i.e. technician), or one year of working in complex medical office/practice
  • One year experience must include working with medical protocols, patient billing, various payors, registration and the referral process, chart review, and knowledge of ICD and CPT coding
  • Thorough understanding of prior authorization as necessary for specialty medications and ability to navigate that process, including external resources
  • Ability to communicate and relay information in meaningful way to achieve successful outcomes for patients
  • Strong analytical and documentation skills
  • Strong orientation toward customer service
  • Previous experience working with patient assistance programs, working within Epic Hyperspace or Willow Ambulatory (preferred)
  • National pharmacy technician certification (CPhT) preferred

Specialty Pharmacy Account Liaison Resume Examples & Samples

  • Manages major account relationships as the primary point-of-contact for day-to-day issues, including ongoing communications, and coordination of project, billing and other activities
  • Demonstrated ability of managing projects driven by new business opportunities
  • Ability to provide resources responsible for managing the relationship and ensuring delivery of contractual obligations
  • Preparation of standard client monthly reporting packets and ad hoc reporting as requested by the client
  • Create and execute project work plans and revise as appropriate to meet changing needs and requirements
  • Facilitate regular client meetings effectively
  • Conduct regular business review session with key clients
  • Resolves and/or escalates issues in a timely fashion
  • Serve as a liaison with IT Services to facilitate projection completion for assigned clients
  • Identifies opportunities for improvement and makes constructive suggestions for change
  • Builds a knowledge base of each client's business, organization and objectives
  • Suggests areas for improvement in internal processes along with possible solutions

Senior Program Manager Specialty Pharmacy Programs Resume Examples & Samples

  • Evaluates vendor performance and ensures compliance with contractual standards and applicable federal regulations. Evaluates operational processes and assesses the impact on program and member services relative to FEP performance goals. Investigates non-performance and directs vendor efforts to ensure corrective actions are implemented timely. Assumes leadership role among staff to ensure appropriate delivery of member benefits consistent with FEP policies. Reviews and understands FEP Operations Center (FEPOC) claim processing protocols for prescription drug- claims. Serves as a liaison between FEPOC and PBM in resolving claims processing issues
  • Leads Strategic Initiatives and executes multiple cross-functional projects to maintain and enhance customer satisfaction with FEP Pharmacy Programs. Ensures timely resolution of customer inquires (members, Plans, OPM, Congressionals, Internal FEP Staff). Reviews PBM standard operating procedures (SOP) for Call Center management and training materials and curriculum for customer service representatives to ensure optimal service is provided to FEP members. Reviews Front-end and Back-end pharmacy SOP to ensure optimal service for FEP membership. Monitors Specialty Pharmacy fulfillment and member services
  • Leads the design, development and distribution of multiple communication materials necessary for educating members, Plans and OPM on the structure of the pharmacy benefit. Responsible for ensuring vendor maintains and updates its website and coordinates all updates in sync with the fepblue.org website. Serves as the subject matter expert for the review and update of the Specialty Pharmacy Program policies detailed in the Administrative and Benefit Policy Manual and the Service Benefit Plan brochure
  • Ensures timely receipt and review of all contractual reports – operational, financial, and clinical. Develops report summaries that highlight critical performance metrics for Senior Management review
  • Guides the day-to-day account relationship with the Rare Disease Management Vendor. Evaluates vendor performance and ensures compliance with contractual standards and applicable federal regulations. Evaluates operational processes and assesses the impact on program and member services relative to FEP performance goals. Investigates non-performance and directs vendor efforts to ensure corrective actions are implemented timely
  • Oversees all efforts related to RDM Accreditation. Collaborates with FEP’s Sr. Program Manager of Accreditation and RDM vendor’s Accreditation expert to ensure all Accreditation related policies and reports are up to date and are available to Plan consumption
  • Bachelor’s Degree in Pharmacy, Business, Accounting, Management or Health Services, or the equivalent years of experience
  • Minimum 7 years business experience within a business environment
  • Minimum of 5 years’ experience within a national health care and managed pharmacy delivery system
  • Pharmacy or Master’s Degree in health services degree or equivalent experience
  • Pharmacy related operations experience
  • Progressive experience in large account management and/or project management
  • Ability to manage stakeholders and reconcile and integrate competing interests
  • Prior project/program leadership experience that demonstrates the ability to set priorities and meet objectives for several complex projects involving multiple stakeholders

Infusion Nurse for Specialty Pharmacy Resume Examples & Samples

  • Ensures that professional and skilled nursing care has been provided to assigned patients as outlined in the physician’s Plan of Care
  • Performs a complete assessment of assigned patient’s ongoing physical and emotional status, level of competency, home environment, safety factors and family support available to assist with care and needs of patient
  • Reports to supervisor on services rendered, problems concerning patient’s needs and resolution to those needs; reports to the physician any changes of the patient’s condition and reaction to treatment
  • May participate in the patient care planning conference and revision of Plan of Care as changes occur
  • Provides information on patient rights, reimbursement procedures, and patient/family rights
  • Initiates and applies appropriate preventative, therapeutic and rehabilitative nursing procedures and techniques as ordered by the physician
  • Administers medications and intravenous solutions
  • Completes all documentation in a timely manner; maintains patient clinical records and reports in accordance with company policies and as required
  • Trains patients and/or caregivers in all procedures and equipment; counsels patient and family members regarding patient care needs
  • Participates in on-call rotation as necessary; participates in in-services as required
  • Inventories patient supplies and informs pharmacy of patient needs
  • Coordinates patient’s care with other home care agencies as necessary
  • Provides goal directed care leading to specific outcomes
  • May instruct and supervise other nursing personnel as required
  • May be on call for after-hours work; travels by automobile and requires valid driver’s license and motor vehicle insurance
  • Bachelor’s degree required. BSN is preferred
  • BCLS certification is required
  • At least 1 year experience recent hospital or home care experience. Infusion experience preferred
  • Unrestricted current license as a Registered Nurse in resident state is required
  • Demonstrated knowledge of nursing processes and principles
  • Demonstrated proficiency in IV insertion, vascular access devices and infusion pumps
  • Excellent communication skills, both oral and written

General Manager Specialty Pharmacy Facility Resume Examples & Samples

  • Oversees the management of the Specialty Pharmacy supporting special needs of patients with diseases such as Oncology, Fertility, MS, RH, Hepatitis C, IV, and other disease states managed through prescription and infusion drug therapy
  • Ensures that the facility maintains and improves profitability, through regular reporting, monitoring and management of the Profit and Loss (P&L) reports and statements
  • Develops and monitors key performance indicators to measure, report and improve on time delivery performance to patients, group homes and hospitals and customer satisfaction. Directs and ensures the performance and execution of all areas of the facility, including facility performance, operations plans, organizational structure, schedules, accurate on-time deliveries, and management of the facility human resources
  • Assures that the inventory maintained at the facility is secured, monitored and controlled
  • Negotiates the terms of contracts with group homes and other entities for long term provision of specialty drug therapy for client groups
  • Ensures Pharma programs including facility adherence to Federal trade Commission, Drug Enforcement Agency, federal, state and local laws and regulations; and Corporate and WHS policies and procedures regulating drugs, loss prevention, health and safety
  • Prepares the annual facility budget, including forecasted sales volume and expenditures. Recommends, and directs the facility’s annual payroll and expense budget. Monitors and controls the use of overtime and ensures safety and security of the facility including its inventory and personnel
  • Represents the Company and the facility at community, business, social and public functions (including business and trade associations) in a manner to best serve the company’s interests and to achieve and maintain good public relations for the Company
  • Recommends, implements, and controls policies and procedures designed to identify and minimize profit loss
  • Oversees the implementation and training of facility personnel in the WHS and Walgreen Co pharmacy systems, including Intercom Plus and other requisite facility systems
  • Bachelor’s Degree and at least 5 years of experience in General Manager or senior Manager in a Central Fill Health Care Setting to include Specialty Pharmacy, Mail Service, Home Care, or LTC
  • Knowledge of Profit and Loss statements
  • Experience coordinating and facilitating executive management meetings
  • Experience negotiating with outside vendors, including negotiating contracts, prices, resolving service issues and reconciling differences
  • Experience directly managing people, including hiring, developing, motivating, and directing people as they work

VP-specialty Pharmacy Strategy & Business Development Resume Examples & Samples

  • Develops Lash Group’s strategic growth plan in specialty products and executes through direct sales activities with specialty manufacturers
  • Provides functional expertise, industry knowledge and specific recommendations to Lash Group leadership on specialty products and SPP-related programs, policies, services and finances
  • Gathers and analyzes information on market and industry dynamics that may affect the business relationship between Lash Group and SPPs. These dynamics may include manufacturers' changing requirements, changes in SPP service models and/or new affiliations with payers, manufacturers and other financial stakeholders, competitor strengths and weaknesses relative to SPP strategy and opportunities for new growth
  • Develops business strategies to account for market and industry dynamics and may guide or lead implementation
  • Communicates business strategy related to SPP’s internally through a comprehensive action plan and routine tactical updates to leadership
  • Develops and maintains strong relationships with SPP contacts; seeks new and increased business opportunities through those relationships
  • Visits designated manufacturer and SPP accounts in a manner and frequency that is consistent with the strategies defined in the strategic plan
  • Regularly, monitors and analyzes specialty product industry news, conferences and trends seeking growth opportunities for Lash Group
  • Evaluates customer issues related to specialty pharmacy, identifies root cause, and takes steps to prevent similar issues from arising in the future
  • Responsible for delivering presentations to key manufacturer and SPP contacts; negotiates partnership opportunities
  • Must be willing to work extended hours, as needed, in order to meet strategic objectives; must be willing to travel extensively
  • May have dotted line management responsibility for specialty pharmacy personnel across Lash Group operational programs
  • Routinely monitors current Lash Group programs in the specialty product space and assesses opportunities for improvement in service delivery, operational efficiency and customer experience
  • Assists the Sales Operations team in development of RFP responses specific to specialty products
  • Performs related duties as assigned, at the direction of the SVP, Business Development
  • Deep knowledge of, and practical experience in specialty products, specialty pharmacy operations, service delivery, contracting, finances and performance measurement
  • Ability to learn and understand Lash Group’s service offering and operations
  • Ability to communicate effectively, both orally and in writing, for the purpose of preparing plans, reports and disseminating information
  • Strong interpersonal skills; ability to develop and maintain cooperative business relationships, internally and externally
  • Strong analytic skills
  • Ability to interpret data specific to specialty products, SPPs and/or Lash Group service levels and identify issues requiring action
  • Ability to interpret industry trends and competitive information and develop strategies and tactics to respond to changes in the marketplace
  • Strong creative thinking skills and ability to convert abstract ideas into actionable plans
  • Ability to identify and coordinate sales opportunities for Lash Group’s business development team
  • Working knowledge of computers necessary to operate effectively with company systems and programs
  • Ability to accommodate at least 50% travel

VP Specialty Pharmacy Resume Examples & Samples

  • Provide direction for specialty assets with a focus on optimizing the current model, growing it to a broader, robust, and integrated offering for the Specialty enterprise
  • Responsible for providing guidance and strategy to market leaders in order to develop, grow, implement, and increase overall margin generation activities for the delivery of pharmacy operations
  • Drives process enhancements and new initiatives into the locations, ensuring that the changes are well received by both clients and patients
  • Lead the development and execution of operations strategy to meet the long term market and business objectives for the organization
  • Represent the Senior Leadership Team; accountable for the effective management of operations, development and monitoring of key performance indicators, and appropriate budget and resource allocation in order to serve our customers
  • Manage all key specialty operational systems – benefits verification, referral and order entry, pharmacy and medical coverage eligibility, prior authorizations, dispensing and shipping, purchasing and inventory control, and specialty therapy management
  • Direct the development and implementation of operations information systems, intellectual property regarding operating systems and processes, clinical services and patient care support to achieve optimal patient outcomes and drive physician loyalty and pharmacy decision support; refine operational reporting, tracking, and response systems to ensure a zero defect operation
  • Work with healthcare partners, other insurers, pharmacy benefit managers, employer groups, unions, government and other third party programs to coordinate Specialty Pharmacy and associated Disease Management Services, relevant provider fee schedules, dual coverage issues, and client reporting activities
  • Bachelor’s Degree and at least 15 years of experience leading operations or similar areas for a Pharmacy Benefit Management (PBM), specialty pharmacy, health plan managed care organization, or relevant industry, with a minimum of 10 years in pharmacy benefit management, 5 years in specialty pharmacy
  • At least 5 years of experience planning, developing, and managing departmental expense and capital budgets
  • At least 5 years experience directly managing people, including hiring, developing, motivating, and directing people
  • Willing to travel up to 25% of the time for business purposes (within and out of state)
  • Experience in a senior director/middle management level pharmacy position with comparable responsibility for scope of complexity, organization-wide reach, budgets, subordinate reports and meeting strategic goals
  • Experience in implementation of complex change initiatives (vendor management, process change, marketing and sales strategies, and six-sigma methodology)
  • Experience in representing the company in industry and trade groups, key physician providers, government representatives and regulatory agencies, brokers, and the general public
  • Experience with strategy development and management in a matrix environment
  • Experience leading cross-functional teams to meet business objectives with outstanding results

Specialty Pharmacy Liaison Resume Examples & Samples

  • Provide consistent and effective communication to all appropriate stakeholders as first line support/single point of contact with contracted specialty pharmacies
  • Identify, investigate and resolve escalated issues and cases related to complex reimbursement from both internal and external stakeholders
  • Responsible for analyzing incoming data and recognizing trends and cases that need further action. Review all incoming daily data from the contracted SP, review exception errors generated from each contracted data feed, and outreach to contracted SPs related to outstanding restatements. Ensure all contractual timeframes related to SP data review are successfully met, if applicable
  • Lead weekly (more or less frequently as needed) calls with each contracted SP to review patient statuses to include those at risk of lapsing in therapy, shipment and/or insurance delays, missing shipment and updates. Provide timely tracking of receipt of referral, status of contracted SP activity, and potential interruptions in therapy
  • Provide training and education to contracted SPs about the program, processes, and data requirements
  • Attends manufacturer national sales conferences as applicable
  • Attends manufacturer/SP QBRs and other manufacturer meetings as requested
  • Bachelor’s Degree and 3-5 years of experience or 8-11 years relevant working experience
  • Previous experience in the PBM and/or healthcare industry required
  • 5 years experience in a customer service setting, preferably in a call center environment
  • Proficient in Microsoft Office applications
  • Ability to handle a fast paced environment
  • Demonstrated customer service resolution skills

Specialty Pharmacy Regional Account Manager Resume Examples & Samples

  • Developing/positioning Publix as a Specialty Pharmacy leader and drive Specialty Pharmacy business,
  • Working with the Specialty Clinical and Operations internal team and the Retail locations in the territory to ensure seamless pull through, as it relates to key selling messages,
  • Conducting sales data analyses and monitoring competitor behavior to develop appropriate sales strategies and business plans to generate recognizable increases in business in the assigned territory,
  • Entering all sales call activity into the Customer Relationship Management (CRM) application. The information should be entered for the express purpose of maximizing sales and improving upon the business relationship,
  • Demonstrating expertise and a commitment to maintaining in-depth knowledge of highly complex market dynamics (including payer issues, state and government regulations, provider payment issues, drug launches, etc.) within complex disease states (Oncology, Rheumatology, Cardiology, Infectious Disease, etc.),
  • Partnering with Pharmaceutical Sales Representatives around common objectives to coordinate selling efforts
  • Bachelor’s (BA or BS) degree or equivalent experience
  • 2-3 years of demonstrated, successful outside sales experience in pharmaceuticals or other health related field, OR 2-3 years of demonstrated, successful experience as a Publix monthly, salaried associate,
  • Knowledge of Specialty Pharmacy industry trends, best practices and targeted disease states and corresponding treatment regimens,
  • Knowledge of Specialty Pharmacy processes and procedures
  • Knowledge of Prescribers
  • Knowledge of CRM applications (such as salesforce.com)
  • Negotiation and Persuasion skills
  • Excellent verbal communication and presentation skills
  • Analytical and reporting skills
  • Advanced degree (i.e., MBA, PharmD)
  • 3+ years’ experience as a demonstrated, successful outside medical sales associate (preferably in an Oncology, Infectious Disease or Rheumatology, or Dermatology field)

Specialty Pharmacy Fulfillment Pharmacist Resume Examples & Samples

  • Maintains documentation relative to the job
  • Performs counseling as needed
  • Maintains and fosters and environment of teamwork and engagement
  • Participates in special projects/committees as needed

Specialty Pharmacy Liaison Resume Examples & Samples

  • Understands product and payer reimbursement landscape and prior authorization guidelines and processes
  • Collects and reviews all data needed for prior authorization approvals
  • Resolves insurance related issues, including prior authorizations (PAs), and assist patients with various forms of financial assistance
  • Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly; maintains frequent phone contact with patient, provider and pharmacy staff; and clarifies prescription orders with pharmacist and/or clinician as appropriate
  • Serves as the direct patient and provider contact for pharmacy benefit information, clinical and program information
  • High School diploma or GED required
  • License Pharm Tech Cert Board preferred
  • 3-5 years related work experience required in Healthcare
  • Working knowledge of the 340B program, state and federal laws
  • Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access
  • Associates or Bachelor's degree preferred
  • Pharmaceutical, biotech, or specialty pharmacy industry experience and history of building business relationships from the ground floor with health care strongly preferred
  • Knowledge of medication use in RA, GI, transplant, hepatitis C, infectious disease (including HIV), and/or oncology a plus

Specialty Pharmacy Sales Manager Resume Examples & Samples

  • Defining, developing, implementing, and continually monitoring strategic Sales Team’s objectives and goals to ensure maximum market share and profitability of the Specialty Pharmacy
  • Overseeing and directing the day-to-day activities of the Sales Team to ensure sales monthly, quarterly and yearly goals are being achieved and exceeded
  • Managing, training, coaching, and developing Sales Team associates
  • Managing the Customer Relationship Management (CRM) application (salesforce.com) for the Publix Sales Team
  • Bachelor’s (BA or BS) degree
  • 2-3 years sales experience (preferably in pharmacy, PBM or managed care industry) selling to and maintaining physician office-based accounts
  • Specialty Pharmacy Industry trends and best practices
  • Knowledge of Sales principles, practices, and tactics
  • Knowledge of Prescribers, Manufacturers, and/or Third Party Payers
  • Ability to display professionalism
  • Effective negotiation and persuasion skills
  • Excellent managerial skills
  • Excellent planning, organizational, and time management skills
  • Verbal communication and presentation skills
  • Ability to work with no to little supervision
  • Basic level Microsoft Office skills
  • Willingness to travel
  • 5+ years sales experience in Pharmacy, Healthcare, PBM or Managed Care industry and 2 years’ experience as a manager

Strategic Account Manager, Specialty Pharmacy Resume Examples & Samples

  • A minimum Bachelor’s degree is required
  • A minimum of four (4) years progressively responsible and related specialty pharmacy pharmaceutical experience; experience with sales, the pharmaceutical industry and marketing is preferred
  • Travel (up to 15-20%)
  • Highly-motivated, self-driven contributor
  • Specialty pharmacy experience
  • Ability to work both independently and in a team environment
  • Understands future trends in general health care
  • Experience, knowledge and ability to rapidly learn scientific, medical, financial and regulatory detail as necessary
  • Excellent presentation skills
  • Demonstrates superior organizational and project management capabilities
  • Basic understanding of accounting and financial functions
  • Excellent oral and written communication skills, including ability to present and sell ideas and solutions
  • Dynamic customer relations skills, experienced negotiator
  • Ideal candidate will have specialty pharmaceutical experience with numerous contacts
  • Ability to commit to variable travel schedule as required

Specialty Pharmacy Program Manager Resume Examples & Samples

  • Communicates with multiple branches to validate accuracy of data for manufacturer reporting
  • Develops and implements standard operating procedures to ensure efficient delivery of products and services including billing and collections
  • Forecasts, manages and measures operational performance to ensure meeting the requirements of the defined business plan performance goals and operating budget
  • Establishes and documents work procedures and standards to improve efficiency and effectiveness of the operation including coordination of various functional departments and training of staff
  • Primary contact for the client concerning operational issues
  • Addresses payer-related contract
  • Manages and directs staff of program coordinators billing A/R and administrative staff; responsible for forecasting and hiring additional staff as needed
  • Relies on expert experience and judgment to plan and accomplish goals; a wide degree of creativity and latitude is expected
  • Generates weekly detailed reporting and inventory reporting for manufacturer contracts
  • Responsible for quarterly reconciliation report for manufacturer contacts
  • Compiles and interprets reports relevant to program performance program demonstrated best practices and sales distribution
  • Interfaces with management companies such as the Lash Group and patient assistance foundations as well as the actual manufacturer partner for issues that relate to the day-to-day functionality of the Program
  • Strong leadership and staff development skills
  • Good mathematical skills
  • Ability to resolve issues effectively and efficiently
  • Knowledge of computers necessary to operate effectively with company systems and programs

Program Manager, Specialty Pharmacy Resume Examples & Samples

  • Manage specific aspects of internal program operations and development, including definition of the program vision, roadmap, and customer experience
  • Facilitate dialogue with broad group of cross-functional teams with a demonstrated ability to lead and influence decisions
  • Decisively drive and deliver new program development in a fast paced environment
  • Anticipate bottlenecks, provide escalation management, anticipate and make trade-offs, balance the business needs versus technical and operational constraints, and encourage creative and progressive solutions to maximize business benefit
  • Actively seek, survey, and document customer input for program improvement and drive implementation of enhancements
  • Contribute to the suggested feature set of the program platform by staying abreast of specialty market trends and changes, evolving models, stakeholder dynamics, and pharmacy trends
  • Develop and update the business case to support ongoing and future program investment
  • Partner with Marketing Operations to develop marketing plans to support the launch of program extensions. Help drive go-to-market planning to ensure successful program adoption and engagement
  • Partner with Marketing Communications to team build customer testimonials and marketing collateral
  • Serve as primary point of contact for all vendor and partner relationships
  • Oversee billing and support operations
  • Ensure program invoices and expenses are tracking to budget
  • Define program success metrics and report on program performance, sales, and customer utilization
  • Previous experience in Specialty Pharmacy, or Specialty Pharmaceuticals industry or in-depth knowledge of the Specialty Pharmaceutical market
  • 5 years’ experience with product or program management experience
  • Demonstrated success at defining, launching, and managing new products
  • Previous vendor management experience
  • Ability to provide recommendations around strategic projects and drive approval process with stakeholders and C-level Executives
  • B2B Market facing skills
  • Experience in product/program development, innovation and/or health care (especially retail pharmacy) preferred +
  • Strong strategic skills building value proposition for sales force
  • Ability to facilitate dialogue and work cross functionally with multiple teams (finance, sales, marketing, execs and BD and strategy.)
  • Thorough understanding of pharmacy technology
  • Strengths in structured and logical thinking, problem solving, issue resolution, and attention to detail
  • Strong analytical and quantitative skills, including the ability to link program design and features to strategic objectives and use hard data and metrics to back up assumptions and recommendations
  • Ability to multitask, adapt to changing priorities, be decisive under ambiguity, and meet tight deadlines

Group Supervisor Specialty Pharmacy Resume Examples & Samples

  • Trains and coaches employees and keeps management informed of issues. Meets with employees on a regular basis to provide employee with performance feedback
  • Conducts timely performance evaluations for the subordinate staff; sets specific, measurable and realistic performance objectives; provides constructive feedback and recognition
  • Supervises departmental work activities, ensures accuracy of employee timecards, staffing, and scheduling to achieve business objectives
  • Maintains knowledge of disease states along with related medications and supplies to ensure accurate and complete information and services are provided to patients. Enforces communication guidelines for technician in accordance with pharmacy law
  • Provides support to all areas of the facility and assists with completion of operational duties including but not limited to prior authorizations, scheduled first orders, compliance calls, insurance verification, follow-up, enrolling patients and issue resolution
  • Monitors, audits and reports daily team and individual performance statistics and assists with extrapolation of data from system applications to develop reports regarding productivity trends. Advises management, analyst and trainer of findings and trends
  • Assists in the development, updating and implementation of Standard Operating Procedures related to system applications, programs, processes and merchandise
  • Participates in the recruitment process of potential employees and performance management of current employees including but not limited to screening applicants, interviewing, employment decision, performance evaluations and terminations
  • Acts as an agent of the company by projecting a positive attitude, enthusiasm, team spirit and integrity in order to motivate the team, creating a positive work environment, and reaching and exceeding department goals
  • High School Diploma and at least 1 year experience coaching or leading a work team
  • At least 1 year experience typing a minimum of 25 words per minute
  • At least 1 year experience communicating both verbally (on phone, one-on-one, to groups) and in writing (emails, letters, reports, presentations) to various audiences (work group, team, company management, prospective acquisitions, external clients)
  • At least 1 year experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions
  • At least 1 year experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems
  • At least 1 year experience in coaching, mentoring, and training staff
  • At least 1 year experience in managing teams across business units
  • At least 1 year experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates
  • At least 1 year experience establishing and maintaining relationships with individuals at all levels of the organization, in the business community and with vendors
  • At least 1 year experience directly managing people, including hiring, developing, motivating, and directing people as they work
  • At least 1 year experience in indirect management of team members, including assisting in the development, training and assignment of work/projects to other team members
  • Willing to travel up to 5% of the time for business purposes (within state and out of state)
  • Associates or Bachelor’s Degree
  • At least 1 year experience in healthcare or pharmacy setting

Nurse, Specialty Pharmacy Resume Examples & Samples

  • Associates degree or Bachelor’s degree from an accredited nursing school as a Licensed Practical Nurse (LPN), Registered Nurse (RN), or Nurse Practitioner (NP)
  • Maintain certification as a nurse practitioner/registered nurse from a Board recognized national certification organization, which requires the passing of a national certifying examination in the particular specialty in which the applicant is seeking certification by the Board
  • At least two (2) years Insurance Verification and appeals experience required
  • Previous Medicaid/Medicare experience preferred
  • Prior Authorization review experience preferred
  • Strong organizational skills and a thorough knowledge of computers (Microsoft Office and Windows) are required
  • Demonstrated ability to work independently and meet goals Multi­tasking, Listening, Verbal Communication, Health Promotion and Maintenance
  • Ability to work in a fast paced environment while maintaining a positive attitude
  • Strong oral and written communication skills. Strong team player
  • Commitment to company values
  • Willingness to travel/visit physician office when requested by Sales Team

Pharmacy Tech-specialty Pharmacy Resume Examples & Samples

  • Setup of patient accounts in the pharmacy system and verification of insurance coverage
  • Ensure medication is available for rapid filling of prescriptions
  • Communicates and follow up with physician offices or clinics regarding prior authorizations
  • Works with insurance companies to obtain prior authorizations for patients
  • Ensures any copay assistance or charity care is provided to decrease the patients co-pay
  • Receives prescriptions and process them in a timely manner to ensure rapid delivery of medications
  • Communicate effectively over the phone to patients making refill reminder calls to improve medication compliance
  • Provides expertise and leadership in assigned area. Practices in a unique, specialized area of pharmacy practice as defined by pharmacy leadership
  • Uses resources available to find financial assistance to Specialty Pharmacy patients
  • Audits pharmacy records to determine where the pharmacy may provide more financial assistance
  • Acts a resource to other pharmacy staff members for daily operational issues including, but not limited to, EnterpriseRx troubleshooting, co-pay programs, billing options, shipping issues, and general problem solving
  • Experience in the area of insurance verification
  • Experience in obtaining prior authorizations
  • Experience with copay assistance programs
  • Experience in billing Medicare B and pharmacy claims as a medical benefit
  • Pharmacy Technician Certification Board (PTCB) national certification
  • Communication skills, both written and verbal
  • Ability to communicate clearly and concisely with all patients, caregivers, and clinicians

Manager, Specialty Pharmacy Solutions Resume Examples & Samples

  • Personnel management, including recruiting, training and developing your team
  • Has a strong understanding of the program support tasks needed to support daily operations
  • Ensures an optimal prescription fulfillment service focusing on scheduling on time delivery, reporting, invoicing, ordering, data integrity and communication
  • Manages accurate and timely processing of coordination services activities in compliance with internal and external expectations
  • Coordinates with Finance team to ensure accurate and timely pharmacy invoicing and receivables
  • Proactively provides Network Pharmacists with program enhancements to ensure an efficient patient-focused service
  • Creates strategies and tools for assessing and managing work allocation and work activities across the coordination services team
  • Ensures suitable staffing to meet business needs such as volume increases, absentees and new business
  • Coordinates fulfillments and produces special program and client mailings
  • Manages fulfillment supplies through purchase orders and inventory control
  • A minimum of 3 years of experience in healthcare / pharmaceutical related field
  • Proven customer relationship and/or account management skills with direct client interaction
  • Strong financial acumen and pharmacy coordination experience
  • General knowledge of reimbursement, patient assistance programs, database elements and functionality
  • A Bachelor’s degree program and/or an equivalent combination of experience and education is required
  • A degree in Pharmacy or Health Science could be an asset
  • Strong customer/client management background
  • Exceptional project management skills with experience in organizing, planning and executing projects from vision through implementation
  • Good Analytical, conceptual and problem solving skills with demonstrated track record in new concept development for various projects
  • The ability to manage multiple tasks along a parallel process
  • Ability to resolve associate issues effectively and efficiently
  • Ability to communicate effectively both orally and in writing and in both French and English (oral and written)
  • Posses strong interpersonal and leadership skills

Specialty Pharmacy Fulfillment Technician Resume Examples & Samples

  • Maintains inventory and ordering
  • Communicates and acts as liaison between insurance company, patients, providers, and specialty pharmacy team
  • Maintains efficiency in specialty pharmacy intake technician and specialty pharmacy refill advocate roles; Resonsible for Inventory, Ordering, Filling, and Packaging
  • Assists with special projects/ committees
  • Performs all job duties in accordance with Ochsner Specialty Pharmacy policies and accrediting bodies

Specialty Pharmacy Account Executive Resume Examples & Samples

  • Outstanding performance in developing and maintaining payer and internal customer relationships
  • SP channel experience, preferred
  • Demonstrated competence in financial modeling, budget impact models, and other payer and outcomes analysis
  • Demonstrated competence with business plan development, business management, contract development, negotiation and analysis
  • Outstanding performance as an Account Executive and demonstrated leadership skills in managing and influencing teams
  • Demonstrated excellence in account management, relationship development and account penetration
  • Demonstrated track record of being a significant contributor of high performing teams
  • Expertise in managed care markets, pharmaceutical distribution channels, competitive trends and the impact on UCB’s core brands
  • Reimbursement and MMA expertise
  • Demonstrated competence in leading account teams
  • Proven ability to launch and gain preferred product access with managed markets payers Oncology, CNS, RA, PsA, AS or Crohn’s Disease therapeutic areas
  • Extensive negotiation skills with large complex customers
  • Demonstrated superior account management and project management practices
  • Excellent understanding of biopharmaceutical marketing processes
  • Demonstrated strength in business planning and tactical plan development and execution
  • Excellent understanding of basic finance, return on investment and profitability analysis
  • Excellent understanding of clinical and marketing information on UCB and competitor’s products
  • Strong technology skills (e.g. computer skills – power point, excel, word, internet web sites)
  • Outstanding interpersonal skills and flexibility to meet customer demands

Coordinator, Specialty Pharmacy Resume Examples & Samples

  • Assist in identifying Specialty Pharmacy Formulary and Utilization Management opportunities, including participating in the Pharmacy and Therapeutics Committee reviews as assigned and reviewing the specialty pipeline at least twice a year. Identify, develop and implement evidence-based, policy opportunities specifically around off-label use, understanding LCDs and NCDs, clinical trials, etc
  • Assist in the development and management of a strategic plan for Specialty Pharmacy Management services
  • Assist in the development of clinical programs to wrap around our owned pharmacy specialty distribution programs
  • Assist in the development, implementation, and ongoing evaluation of the Health Plan's Specialty pharmacy offerings. Develop and manage pharmacy initiatives that efficiently focus on quality, appropriate and cost-effective utilization and client, member and provider satisfaction
  • Coordinate with internal operations teams to monitor the appropriate configuration of specialty medications
  • Critically review of medication based prior authorization requests for approval/denial against standard criteria
  • Interface with external partners, providers, clients, or customers, to ensure optimal Specialty prescription benefit design, implementation, and processes, including our specialty pharmacies
  • Mentor students and residents as a preceptor
  • Participate in committees relevant to strategic issues impacting specialty pharmacy
  • Regularly review and analyze department reporting to ensure compliance with the business plan and Health Plan processes and strategy
  • Responsible for ensuring timely and accurate regulatory reporting and compliance with regulatory and accreditation requirements if applicable
  • Through data analysis and drug utilization evaluations, identify and implement evidence based, best practice utilization opportunities within both the medical and pharmacy drug utilization translating these targets into effective UM strategies
  • 3 years experience in a progressively more responsible managed care pharmacy setting
  • Experience in specialty pharmacy benefit management, insurance, managed care preferred and be knowledgeable in therapeutic interventions and other cost containment programs
  • Computer literacy for pharmacy programming, word processing, data management
  • Assessment of job related skills and competency will be reviewed annually via daily functioning, job-related documentation, department based competency programs, and continuing education activities