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Pharmacy Specialist MJHS Job Description Job DescriptionThe challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
The Pharmacy Specialist will perform duties to support the efforts of Elderplan Pharmacy Department in the development, coordination, and maintenance of the plan’s pharmacy program. These duties involve administrative tasks and outreach calls to members, providers, and pharmacies as directed by the supervisor. Reviews and identifies opportunities for FWA (fraud, waste, and abuse) control through a review of high-cost drug claims as directed by pharmacists. All outreach activities, documents and reporting requirements are prepared and conducted in a professional and well-coordinated manner to comply with all Part D regulations and guidance.
Bachelor's degree required 1-2 years experience of general office or administrative, pharmacy and/or pharmaceutical managed care or insurance environment 1-3 years of experience in analyzing pharmacy claims data to identify trends and summarize outcomes, Knowledge of Part D regulations, PBM and Star Quality measures for Medicare is strongly preferred. Strong interpersonal and organizational skills Bilingual English/Spanish a plus Excellent written and verbal communication skills Proficiency Excel, Word, Visio required Experience in Medicare, Medicaid and/or Pharmacy retail strongly preferred New York, NY, USPosted 5 hours ago Classroom Aide/Without Walls Day Program Assistant. Ability Beyond Assist adults w/ developmental and physical disabilities either in a classroom site based day program setting OR in an off site community based day program setting. Integrate people w/ disabilities into the community to participate in recreational, leisure, and/or volunteer activities. Role model socialization skills for people w/ disabilities Assist people w/ disabilities with daily living such as personal care as needed. Transport people w/ disabilities to and from day program and/or recreational outings. Help people w/ disabilities achieve their goals based on their preferences and abilities. Ensure proper electronic and physical documentation of daily individualized case notes Collaborate with an interdisciplinary team that includes nurses, behaviorists, & nutritionists Benefits: Extensive paid training and certification program Generous benefit package (medical, dental, vision, pet insurance) Paid time off (increases over years of service) Self-directed retirement plan options (403B) PSLF loan forgiveness eligibility NYS Healthcare Worker Bonus eligibility Flexible work schedules and overtime available that allow for work life balance Access to an Employee Assistant Program including mental health resources Ongoing diversity, equity, inclusion, & belonging initiatives Accredited certification programs in direct care, leadership, and other specialties Employee mentorship program Opportunities for growth and advancement A culture of appreciation, respect, and teamwork Qualifications: High School Diploma or Equivalent Valid Driver’s License is required Willingness to learn, no experience needed To see a day in the life our Ability Beyond workforce, check out this video: PandoLogic. Keywords: Day Program Assistant, Location: New Rochelle, NY - 10801 , PL: 592588778 New Rochelle, NY, US, 10801Posted 5 hours ago Employment Specialist - Human Services ! Ability Beyond You will network to identify opportunities in the individual's preferred field, provide supplemental training for the clients on the job, and provide support to help clients maintain their employment. Danbury, CT, US, 06810Posted 5 hours ago Coordinator of Care RN. MJHS MJHS is a large not-for-profit health system in the Greater New York area. Our range of health services include home care, hospice and palliative care for adults and children, rehabilitation and nursing care at Menorah and Isabella Centers, and the research based MJHS Institute for Innovation and Palliative Care. We also offer Elderplan/HomeFirst: health plans for Medicare and dual-eligible individuals. As a not-for-profit organization, many of our programs and services are made possible through the generosity of grateful families, corporate donors and grants, as well as our own employees. New York, NY, USPosted 5 hours ago Contracting Administrator. MetroPlusHealth MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. New York, NY, USPosted 5 hours ago Medicare Care Managment Team Lead (RN) MetroPlusHealth Under the direction of the Senior Director of Integrated Case Management or Designee, the Medicare Care Manager Team Lead manages day to day activities of the case management team (Case Managers and Case Management Associates) to ensure quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction) and cost effectiveness. This is accomplished through hands-on, participatory management where all aspects of day-to-day case management operations are supervised and feedback is shared with the leadership team for the purpose of meeting program goals and the implementation of continuous quality improvement strategies. The Medicare Care Manager Team Lead spends approximately 80% of the time in the field to provide on the job training, supervise visits, ongoing support and mentorship. New York, NY, USPosted 5 hours ago Social Worker (Per Diem) MJHS MJHS is a large not-for-profit health system in the Greater New York area. Our range of health services include home care, hospice and palliative care for adults and children, rehabilitation and nursing care at Menorah and Isabella Centers, and the research based MJHS Institute for Innovation and Palliative Care. We also offer Elderplan/HomeFirst: health plans for Medicare and dual-eligible individuals. As a not-for-profit organization, many of our programs and services are made possible through the generosity of grateful families, corporate donors and grants, as well as our own employees. New York, NY, USPosted 5 hours ago Managed Care Coordinator II. MJHS The Managed Care Coordinator (MCC) is expected to insure high quality, cost-effective care and services for Elderplan/HomeFirst members through support of professional Care Management activities. The position supports all aspects of care coordination for our Medicaid, and/or dual product members in compliance with all departmental and CMS/DOH regulatory requirements. The position requires excellent communication and organizational skills to facilitate superior care management and to act as a liaison between the members, the care management team, and the vendors. New York, NY, USPosted 5 hours ago Restorative Nurse's Aide (RNA) Jersey Shore Post Acute Rehabilitation and Nursing Restorative Nurse's Aide (RNA) for Jersey Shore Post Acute Rehabilitation and Nursing in Neptune Shift/hours: FT Working at Jersey Shore Post Acute truly means becoming a member of our family. We believe caring for seniors is a uniquely rewarding experience and there is no better place to realize that experience than with a Jersey Shore Post Acute employee, you will be an integral member of our team, and share in the opportunity to make a difference in the lives of our residents each and every seeking Restorative Nurse's Aide (RNA) for our facility Join a fantastic environment and great nursing team! We offer: Competitive Pay Bonuses Flexible Schedules Advancement Opportunities Apply today! Required License/Certifications: CNARNA Neptune City, NJ, USPosted 5 hours ago Physician Obstetrics and Gynecology. CompHealth New York City is not all bright lights and skyscrapers. They also have wildlife refuges, botanical gardens, parks, and miles of beaches, all of which you can see on Staten Island, the city's greenest borough. The island's other sights include one of America's longest-operating military forts, a living colonial village, a Chinese sculpture garden, and a Yankees minor league team. New York, NY, USPosted 5 hours ago Description
Job Description Job Description
The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
The Pharmacy Specialist will perform duties to support the efforts of Elderplan Pharmacy Department in the development, coordination, and maintenance of the plan’s pharmacy program. These duties involve administrative tasks and outreach calls to members, providers, and pharmacies as directed by the supervisor. Reviews and identifies opportunities for FWA (fraud, waste, and abuse) control through a review of high-cost drug claims as directed by pharmacists. All outreach activities, documents and reporting requirements are prepared and conducted in a professional and well-coordinated manner to comply with all Part D regulations and guidance.
Bachelor's degree required 1-2 years experience of general office or administrative, pharmacy and/or pharmaceutical managed care or insurance environment 1-3 years of experience in analyzing pharmacy claims data to identify trends and summarize outcomes, Knowledge of Part D regulations, PBM and Star Quality measures for Medicare is strongly preferred. Strong interpersonal and organizational skills Bilingual English/Spanish a plus Excellent written and verbal communication skills Proficiency Excel, Word, Visio required Experience in Medicare, Medicaid and/or Pharmacy retail strongly preferred View more..