- Humana (Frankfort, KY)
- …real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional, you will play a pivotal role in resolving outstanding ... drive your career forward. Join us and take the lead on building solutions that make a difference! The...on building solutions that make a difference! The Senior Pharmacy Claims Professional analyzes and answers inquiries… more
- Elevance Health (Louisville, KY)
- ** Pharmacy Internal Auditor** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our ... new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. The ** Pharmacy Internal Auditor** is responsible for… more
- Walgreens (Louisville, KY)
- …and supports the pharmacy manager in analyzing performance data including pharmacy financial , customer service, and implementation of procedures for ... **Job Description:** **Job Summary:** Engages in post-graduate pharmacy activities under direct supervision of licensed pharmacist to fulfill the State Board of … more
- Prime Therapeutics (Frankfort, KY)
- … pricing strategies, financial contract management, profit drivers and the organization's financial value statement + Lead the development of financial ... pricing or financial analysis to include 5 years of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare, and/or related field + 3… more
- Prime Therapeutics (Frankfort, KY)
- …Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data ... to contribute to the development of new or enhanced financial pricing strategies. This position will also lead... financial pricing models to monitor performance against pharmacy claims data and identify financial… more
- Elevance Health (Louisville, KY)
- …provider communications regarding formulary changes. + Ensure appropriate formulary set-up and claims adjudication. + Serve as a clinical pharmacy resource to ... technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. The **Pharmacist** is responsible for managing the selection and… more
- Elevance Health (Louisville, KY)
- …unit and other departments for complex issues and interpretation of claims , provider contracts and data, eligibility, member contracts, benefits, clinical decisions, ... pharmacy on pre-service and post service appeals and grievances...of 3 years leadership experience in grievances & appeals, claims or customer services in the healthcare industry; or… more
- Prime Therapeutics (Frankfort, KY)
- …effective solutions to complex business problems. + Experience with healthcare medical and pharmacy claims data manipulation and analysis. + Master's degree in ... **Job Description Summary** Design, document, develop and roll out financial , clinical and utilization analyses using a variety of...quality. This position has the responsibility to participate and/or lead in defining the issues to be studied as… more
- Molina Healthcare (Louisville, KY)
- …providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements ... clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director, and quality improvement staff. + Facilitates conformance… more
- Prime Therapeutics (Frankfort, KY)
- …of the account including financials, operations, and overall performance. This role will lead a team to develop and execute account plans including retention and ... to build strong relationships and drive partnership on operational efficiency, financial success, and customer satisfaction for the account. **Responsibilities** + … more
- Molina Healthcare (Louisville, KY)
- …line of businesses. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy , Lab and related financial data like risk score, ... Conduct root cause analysis for business data issues as assigned by the team lead . + Analyze data sets and trends for anomalies, outliers, trend changes and… more