123 director of pharmacy services jobs found

The Director, Managed Care Services & Vendor Management is responsible for the strategic oversight, operational performance, and continuous improvement of all medical management programs within MEMIC. This role leads internal clinical teams and manages external medical management vendors to ensure high-quality, cost-effective care for injured workers while supporting optimal claim outcomes. This position plays a critical role in driving medical cost containment, improving return-to-work outcomes, and ensuring compliance with jurisdictional workers’ compensation regulations. Principal Duties and Responsibilities: 1.      Design and execute medical management strategies that support early intervention and injury triage, ensure appropriate utilization of medical services, and promote timely return-to-work outcomes. 2.      Establish clear productivity, quality, and outcome-based performance expectations tied to claim outcomes, and ensure consistent...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE:  To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim.  These responsibilities may include utilization review, pharmacy oversight and care coordination.    This position is remote with a preference of working hybrid out of one of our AmTrust office locations! Responsibilities Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform...

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.   Job Description: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK. The opportunity: We are seeking a Senior Manager, Claims Services to lead a high-performing team supporting Stop Loss & Health Claims Services....

Job Description Sompo has a unique opportunity for a VP, Audit Director, to join our North America Internal Audit team. The VP, Audit Director is the assurance leader responsible for the oversight, execution, and continuous evolution of Internal Audit coverage across the North America Insurance business, aligned with Sompo International’s global Internal Audit strategy, standards, and methodology. This role plays a critical leadership position within the Internal Audit function, with accountability for risk assessment, audit planning, execution quality, stakeholder engagement, and Audit Committee reporting across U.S.-based insurance operations. The Audit Director partners closely with business leadership, risk and compliance functions, and global Internal Audit peers to deliver risk-based, forward-looking assurance over governance, risk management, and internal controls. This role is instrumental in ensuring Internal Audit remains independent, value-added,...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE:  To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim.  These responsibilities may include utilization review, pharmacy oversight and care coordination.   This position is hybrid out of Irvine, CA, Scottsdale, AZ or Salt Lake City, UT.  Responsibilities Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform Utilization Review activities...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim.  These responsibilities may include utilization review, pharmacy oversight and care coordination.    This position will be hybrid out of our Dallas, TX or Overland Park, KS office. Responsibilities Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform Utilization Review activities...

The CERIS Implementation Director is responsible for providing strategic leadership and oversight for the implementation of new and existing client programs, product enhancements, and service expansions. This role ensures the successful execution of complex implementations while aligning implementation strategy with organizational objectives, operational readiness, and long‑term client success. The CERIS Implementation Director works closely with executive leadership, Account Management, Implementation Managers and Coordinators, IT, Operations, Product, and Sales to ensure consistent, high‑quality delivery and a seamless transition to ongoing account management and field operations. This role is also accountable for leading and developing the Implementation team and continuously improving implementation processes across the organization. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides overall leadership and accountability for the...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim.  These responsibilities may include utilization review, pharmacy oversight and care coordination.    This position will be hybrid out of Maitland, FL or Boca Raton, FL office.  Responsibilities Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform Utilization Review activities prospectively,...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim.  These responsibilities may include utilization review, pharmacy oversight and care coordination.    This position will be hybrid out of our Alpharetta, GA or Dallas, TX office. Responsibilities Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform Utilization Review activities prospectively,...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE:  To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim.  These responsibilities may include utilization review, pharmacy oversight and care coordination.   This position is hybrid out of Irvine, CA, Scottsdale, AZ or Salt Lake City, UT.  Responsibilities Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform Utilization Review activities...

Overview AmTrust Financial Services, a  fast growing  commercial insurance company, has a need for a Complex Care Case Manager, RN for Workers Compensation managed care team.     PRIMARY PURPOSE :   The  complex care case manager will provide comprehensive and quality telephonic case management for our injured employees with complex diagnoses and often catastrophic injuries. Our nurses will  be responsible for  proactively applying clinical  expertise  ensuring our injured employees receive medically  appropriate healthcare  to achieve a safe return to work or best  optimal  level of function through engagement with the injured employee,  provider  and employer. Our nurses will be empathetic informative medical resources for our injured employees, and they will partner with our adjusters to develop a personalized  holistic approach  for each claim.  These responsibilities may include  utilization  review, pharmacy oversight...

As a Director - Health and Benefits Consulting, you will be a leader on the client service team and will be responsible for fostering relationships cross the client organization. You will be responsible for managing a wide array of projects, leveraging your experience to make recommendations on plan design and management for the full array of health and benefits programs. You will have the opportunity to generate business by participating in new business activities and expanding existing client engagements.  You will have the opportunity to position yourself to grow into a senior relationship management and/or leadership role by serving as the pivotal point of contact on all projects and working alongside industry experts on cutting edge solutions. The Role Lead the design/management of group medical, dental, wellbeing, disability and time off plans for clients. Responsibilities include: Serving as lead project manager for clients; materially contributing to project plan...

Overview The Director of Pharmacy is responsible for supporting the AVP of Medical Cost Containment in the implementation, process improvement, and optimization of clinical programs. The Director of Pharmacy will be responsible for analytic measurement and improvement of medical management of their assigned programs. These programs may include pharmacy and other associated operational processes and interventions. This role will achieve outcomes by focusing on analytics, clinical operations, and development of new programs to support organizational vision, and cost savings. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust organization. Responsibilities Serve as a business owner for medical product management needs specific to pharmacy program and establishing key performance indicators, identifying opportunities, and driving business goals Manage a team of 8...

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of...

The Workers’ Compensation Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The WC Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises WC claims staff in their day-to-day operations Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers’ Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial approval) Provides technical and jurisdictional...

As one of the leading writers of Federal Crop Insurance, AgriSompo North America combines industry experience, resources, capital and talent to deliver both traditional and innovative crop insurance and productivity tools to farmers, ranchers, insurers and agribusinesses in the United States. Our organization operates within a culture rooted in ethics, integrity and a belief that accountability, collaboration and agility are crucial to long-term success.  AgriSompo North America is a part of AgriSompo, Sompo International’s global agriculture platform. This platform is an integrated underwriting, technology and distribution platform delivering innovate insurance and reinsurance solutions to agriculture partners worldwide.  Sompo International, AgriSompo’s parent company, is a global organization driven by its core values, a carrier that holds promise, trust and the commitment to protect.  Through operating subsidiaries, Sompo International writes agriculture, casualty and...

Job Description Are you looking for your next opportunity?   Sompo has a unique opportunity for an Underwriting Technician on our Excess Casualty team.   Our Excess Casualty team brings extensive expertise and maintains strong, long-standing relationships with a select group of appointed retail brokers. We provide a consistent underwriting approach and efficient turnaround times and are supported by an experienced claims team. We operate through a network of retail brokers who value long-term partnerships supported by a strong and reliable service commitment.   Location: This position will be based out of our New York, NY office. We strive for collaboration, which is why we offer a work environment where our employees thrive and develop long-lasting careers. Our business, your impact, our opportunity: What you’ll be doing: Assist underwriters with reviewing submissions, prepare Workbooks, drafting quotes, binders, policies, endorsements, and...

WORK LOCATION: Remote   JOB OVERVIEW: This role comes at a pivotal moment for the organization. The pharmacy and broader healthcare market are highly dynamic, shaped by ongoing cost pressure, regulatory change, evolving benefit design, specialty drug growth, increasing demand for transparency and performance accountability, and continued disruption across the payer and PBM landscape. These forces are creating significant opportunities for consulting support as health plans seek more sophisticated strategies, stronger analytics, and practical execution support to improve affordability, outcomes, and operational performance. The business is also experiencing a period of meaningful leadership transition, including planned retirements and leadership changes across the Health Plan segment and broader organization. These transitions are being actively managed through structured succession planning and thoughtful organizational design to ensure continued client...

The Workers’ Compensation Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The WC Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This role is available for both remote and hybrid work arrangements. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises WC claims staff in their day-to-day operations Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers’ Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial...

As one of the leading writers of Federal Crop Insurance, AgriSompo North America combines industry experience, resources, capital and talent to deliver both traditional and innovative crop insurance and productivity tools to farmers, ranchers, insurers and agribusinesses in the United States. Our organization operates within a culture rooted in ethics, integrity and a belief that accountability, collaboration and agility are crucial to long-term success.  AgriSompo North America is a part of AgriSompo, Sompo International’s global agriculture platform. This platform is an integrated underwriting, technology and distribution platform delivering innovate insurance and reinsurance solutions to agriculture partners worldwide.  Sompo International, AgriSompo’s parent company, is a global organization driven by its core values, a carrier that holds promise, trust and the commitment to protect.  Through operating subsidiaries, Sompo International writes agriculture, casualty and...