45 pharmacy benefits consultant jobs found

Company: Mercer Description: We are seeking a talented individual to join our MercerRx Pharmacy Practice at Mercer. This role will be based in Minnesota. This is a hybrid role that has a requirement of working at least three days a week in the office. As a Senior Pharmacy Financial Consultant, you will serve as a senior resource within AFG, focusing on reviewing policy and modeling issues related to pharmacy trends. You will lead consulting engagements with large employers regarding the financial evaluation of pharmacy benefit plans and assist in negotiations with benefits carriers and vendors. We will count on you to: Manage pharmacy projects and junior staff in program reviews, financial assessments, implementations, plan design analyses, and financial projections. Establish effective relationships with carriers and vendors to enhance client benefits procurement and administration. Leverage Mercer's size and reputation to negotiate competitive rates and coverage...

For over 20 years PSG has been singularly focused on helping our clients navigate the complex and ever-changing challenges of drug management. Through our leading pharmacy intelligence and technologies, we save our clients billions of dollars every year with an unwavering commitment to serving as the plan’s advocate and strategic partner. Our mission is to relentlessly advocate for our clients as we partner together to develop innovative drug management solutions that deliver exceptional strategic insights, financial and clinical value. The Pharmacy Benefit Consultant - Health Plans will serve as primary and lead consultant on strategic clients’ projects with a focus on national and regional health plans. Lead and cultivate multi-level client relationships with senior executives, pharmacy department leadership and personnel, sales and product leads, clinical management and others which enable PSG to partner with clients to create, communicate and implement...

HUB International Limited (“HUB”) is the 5th largest global insurance broker, providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth management products and services. With over 20,000 employees in 750 offices throughout North America, HUB has grown substantially, in part due to our industry leading success in mergers and acquisitions. We are seeking a Associate Financial Consultant for our Employee Benefits Team. General Purpose Responsible for providing assistance and support to Clients, Producers and Client Relationship Managers on new and renewal accounts in accordance with the practices, policies and procedures of the Company. Core Responsibilities (include but not limited to) Manage data collection process Prepare analytics and reporting of clients for client management team on a regular basis. Assist in developing, enhancing and maintaining underwriting methods and techniques. Manage...

Company: Description: Our not-so-secret sauce. Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result of hard work by extraordinary people. More than 11,000 of the industry’s brightest talent drive our efforts to deliver purposeful work and meaningful impact every day. Learn more about what makes us different and how you can thrive as an Employee Health & Benefits Sr. Client Executive at Marsh McLennan Agency (MMA). MMA provides business insurance, employee health & benefits, retirement, and private client insurance solutions to organizations and individuals seeking limitless possibilities. With 200 offices across North America, we combine the personalized service model of a local consultant with the global resources of the world’s leading professional services firm, Marsh McLennan (NYSE: MMC). Applicants must be within driving distance to the Lexington office to be considered for this role and have the ability to commute...

The Medical Allocator creates a cost projection of a patient’s medical treatment needs by reviewing medical records and identifying a pattern of care. The medical cost projection, also knowns as a Medicare Set-Aside (MSA) report, is part of a workers’ compensation or liability claim settlement.  The Medical Allocator will rely on their medical knowledge and guidelines provided by the Centers for Medicare and Medicaid Services (CMS) to evaluate the patient’s treatment plan for future medical treatment needs.  Work from home possible.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Collaboration with the claim adjuster Review medical records to prepare a Medicare Set-Aside allocation (MSA) report Perform evidenced based medical research Utilize medical knowledge to outline the patient’s medical treatment. Assign pricing to medical treatment allocations Assign pricing to medication allocations Prepare submission of MSA report to CMS for review and approval...

Company: Mercer Description: Mercer Government is seeking a dynamic and experienced Senior Government Consultant I – Pharmacy Project Leader to join our Human Services Consulting (GHSC) team. This role will be based in Phoenix, Atlanta, D.C., or Minneapolis. This is a hybrid role that has a requirement of working at least three days a week in the office. Mercer’s Government Human Services Consulting (GHSC) practice has touched more than 60 million lives since our inception in 1985, working with state Medicaid agencies to transform Medicaid programs to better serve our most vulnerable communities. Our nearly 500 specialists provide comprehensive services including actuarial and financial, clinical and behavioral health, pharmacy, policy, and more. What can you expect? As a key member of our multi-disciplinary team, you will lead projects that support State Medicaid and CHIP programs, ensuring that financial, policy, and clinical considerations are effectively addressed....

As a leading provider of insurance and reinsurance with worldwide operations and employees in Bermuda, U.S., U.K., Continental Europe and Asia, we recognize that our success is derived directly from those who matter the most: our people . At Sompo International, our values of integrity, collaboration, agility, execution and excellence underpin our culture and our commitment to providing an employee experience that attracts and engages the best talent in the industry. As we continue to grow, we strive to find diverse, innovative and driven professionals to join our teams and offer a broad range of career and development opportunities at all levels, in multiple business areas, in each of our locations throughout the world.  Our compensation and benefits programs are market driven and competitive, with excellent family friendly policies and flexible working provisions. Job Description Are you looking for your next opportunity?     Sompo has a unique...

The Care Advocate Nurse oversees initiatives surrounding assessing the severity of the injured workers’ reported injury(ies), reviews medical data in CareMC, validates and secures medical information, assesses and evaluates prescribed treatment of work related injury. The Care Advocate Nurse functions as a nurse consultant, supporting the goals of the Claim Management department and of CorVel. This is a remote opportunity. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Initiates and receives telephonic contact with reported injured worker, employer and medical providers to obtain treatment plan, secures medical documentation, and assesses if injured worker has returned to work Responsible for detailed documentation within the claim system focusing on medical condition, treatment plan and return to work status Directs callers to appropriate medical and/or claim resources Identifies and communicates urgent situations related to treatment or patient condition directly to...

The Certified Nurse Life Care Planner develops reports based upon  treatment history and medical treatment  guidelines. The report outlines the future medical and non-medical expenses of individuals workers’ compensation or other liability claims. The Certified Nurse Life Care Planner will rely on their medical knowledge to evaluate the patient’s treatment plan for future medical treatment needs supporting the goals of the Life Care Plan /Medicare Services department, and of CorVel.  Work from home possible.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Organize medical records into chorological order. Assess, review and summarize medical records in a clear, concise manner. Perform evidenced based medical research regarding unfamiliar diagnoses and future medical needs. Ability to utilize medical and nursing knowledge to compile comprehensive list of necessary future medical expenses. Assign CPT coding and pricing to all future medical expenses. Assign NDC...

The Medicare Set-Aside Consultant develops reports based upon guidelines provided by the Centers for Medicare and Medicaid Services outlining the future Medicare-covered expenses of individuals whose workers’ compensation or other liability claims are in the settlement process. The Medicare Set-Aside Consultant will rely on their medical knowledge to evaluate the patient’s treatment plan for future medical treatment needs supporting the goals of the Medicare Services department, and of CorVel.  Work from home possible.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Organize medical records into chorological order. Assess, review and summarize medical records in a clear, concise manner. Perform evidenced based medical research regarding unfamiliar diagnoses and future medical needs. Ability to utilize medical and nursing knowledge to compile comprehensive list of necessary future Medicare-covered expenses. Assign CPT coding and pricing to all future Medicare-covered...

The Qualified Rehabilitation Consultant (QRC)/Vocational Case Manager provides vocational rehabilitation services and medical case management to individuals following a work place injury through coordination with client, insurer, physician, employer, attorney and others with the ultimate goal being the client’s timely return to gainful employment. The Vocational Case Manager interviews and evaluates the client to determine the degree of disability, eligibility and feasibility of vocational rehabilitation services. This position determines suitable job goals consistent with the clients’ interests, aptitudes and physical limitations; supporting the goals of the Case Management department, and of CorVel. Candidates with case management experience or vocational rehabilitation background encouraged to apply This is a Minnesota Field Case Management position. Only MN candidates will be considered. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Schedule and carry out...

The Care Advocate Nurse oversees initiatives surrounding assessing the severity of the injured workers’ reported injury(ies), reviews medical data in CareMC, validates and secures medical information, assesses and evaluates prescribed treatment of work related injury. The Care Advocate Nurse functions as a nurse consultant, supporting the goals of the Claim Management department and of CorVel. This is a remote opportunity. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Initiates and receives telephonic contact with reported injured worker, employer and medical providers to obtain treatment plan, secures medical documentation, and assesses if injured worker has returned to work Responsible for detailed documentation within the claim system focusing on medical condition, treatment plan and return to work status Directs callers to appropriate medical and/or claim resources Identifies and communicates urgent situations related to treatment or patient condition directly to...

Come join our team! There are many reasons why EPIC Insurance Brokers & Consultants has become one of the fastest-growing firms in the insurance industry. Fueled and driven by capable, committed people who share common beliefs and values and “bring it” every day, EPIC is always looking for people who have “the right stuff” – people who know what they want and aren’t afraid to make it happen. Headquartered in San Francisco and founded in 2007, our company has over 3,000 employees nationwide. With locations spread out across the U.S., our local market knowledge and industry expertise helps support our clients' regional and global needs. We have grown very quickly since our founding, and we continue to see growth and success thanks to our hard-working and growth-minded employees.  Our core values are: Owner mindset, Inspire trust, Think big, and Drive results. If these values and growth align with what you're looking for in your next career? Then consider joining our...

Company: Marsh McLennan Agency Description: As a key member of our Actuarial & Client Informatics team, the Informatics Consultant/Specialist is responsible for collecting, organizing, summarizing, analyzing, and reporting data from carriers and vendors in an accurate and timely manner. This role supports the Underwriting & Pharmacy practice by providing quantitative reports and effectively communicating findings. The ideal candidate will possess a blend of business acumen and technical skills, enabling them to leverage various tools to enhance data analysis and reporting processes. Key Responsibilities: Develop and customize reports for internal stakeholders using tools such as Power BI, SQL Server, Excel, and PowerPoint, incorporating current and prospective client data. Conduct data analysis utilizing knowledge of employee benefits and data handling to support business improvement and strategy projects, providing insights on population, cost, utilization...

Company: Marsh McLennan Agency Description: Actuarial Analyst Our not-so-secret sauce. Award-winning, inclusive, Top Workplace culture doesn’t happen overnight. It’s a result of hard work by extraordinary people. The industry’s brightest talent drive our efforts to deliver purposeful work and meaningful impact every day. Learn more about what makes us different and how you can make your mark as an Actuarial Analyst at MMA. Marsh McLennan Agency (MMA) provides business insurance, employee health & benefits, retirement, and private client insurance solutions to organizations and individuals seeking limitless possibilities. With offices across North America, we combine the personalized service model of a local consultant with the global resources of the world’s leading professional services firm, Marsh McLennan (NYSE: MMC). A day in the life. As our Actuarial Analyst on the Employee Health & Benefits team, you’ll be responsible for analytical...

Company: Mercer Description: Mercer is seeking candidates for the following position. We are looking for an individual to join our Mercer Government Human Services Consulting (GHSC) team who has experience and knowledge related to Medicaid managed care and external quality review (EQR). We are seeking individuals with expertise in managing complex projects and leading multi-disciplinary project teams to help states achieve their Medicaid program goals. Candidates will be hybrid-based, depending on proximity to one or our Mercer offices. Senior Government Consultant – EQR Project Specialist What can you expect? The Senior Government Consultant I will help lead complex projects with Mercer Government’s clients. Our clients are primarily State Medicaid and Children’s Health Insurance Program (CHIP) agencies and related state agencies responsible for Medicaid and CHIP fee-for-service and managed care programs. Responsibilities of this role include...

The Opportunity Are you a strategic thinker with a passion for optimizing pharmacy benefits and driving client success? As a Pharmacy Solutions Consultant at M3's Ethica Pharmacy Advisors, you'll play a pivotal role in managing client relationships, driving sales, and delivering exceptional value through data-driven insights. This position offers an exciting blend of client management, business development, and analytical problem-solving, making it an ideal opportunity for ambitious professionals looking to make a significant impact in the pharmacy benefit management space.   How You Will Make an Impact Develop and maintain strong relationships with clients, pharmacy benefit managers (PBMs), and key stakeholders, ensuring their needs are met and exceeded. Lead client meetings, including quarterly reviews, renewal discussions, and strategic planning sessions to optimize pharmacy benefit plans. Identify and pursue new business opportunities within existing...

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!   We promise to do what’s right, always. Position Summary: The Strategic Growth Executive is responsible for driving revenue growth and market expansion by executing AffirmedRx’s sales strategy. This role focuses on managing and strengthening regional broker and consultant relationships to generate new business opportunities. Additionally, the position oversees the RFP process from initial discussions to finalist presentations, ensuring smooth coordination to secure new...

POSITION SUMMARY: HUB International is seeking to add an experienced Financial Consultant to our growing Data Analytics team in our Cincinnati office! The Financial Consultant will be responsible for leading and making recommendations based on in-depth analysis on medical and pharmacy claims and utilization to identify trends and key indicators that ultimately result in actionable plans for HUB’s clients. Ideal candidates for this role will have a strong prowess for using in-depth data to solve problems as well as a passion for delivering data-driven results and recommendations and building a direct relationship with clients. The Financial Consultant position is a hybrid role based out of our Cincinnati office and will report to the Director of Data Analytics. ABOUT HUB INTERNATIONAL: Hub International is a leading full-service global insurance broker and financial services firm providing risk management, insurance, employee benefits, retirement and wealth management...

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is seeking a n Employee Benefits Coordinator to join our growing team in Rochester, NY.     The Employee Benefits Coordinator will p rovide technical backup for the client servicing and production staff, to support the production of new business and retention of current clients.     How You Will Contribute:     Assist other marketing and sales staff in obtaining market information and research.   Document renewal, sales, and insurance operations compliance documents into the agency management database.   Prepare employee census, utilization , stop loss, benchmarking, pharmacy rebating and other similar reports as requested .   Establish, cultivate and manage relations with carriers and vendors....