SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 5 out of 5-Star rating. SummaCare has also been recognized by U.S. News & World Report as being a Best Insurance Company for 2022 Medicare Advantage Plans. Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Summary:
Responsible for medical benefit and specialty drug management and interventions. Responsible for first line utilization management reviews and maintaining/updating clinical criteria for drugs covered under the medical benefit. Management of the site of care and white bagging programs, develop new strategies and engage providers and/or members to conduct clinically and financially meaningful interventions that impact member drug therapy. These interventions are aimed at improving pharmaceutical care for our members and reducing total cost of drug therapy.

1. Formal Education Required:
a. Pharm. D. or Bachelor degree in pharmacy from an accredited College or School of Pharmacy. Must be a licensed pharmacist within the United States.

2. Experience & Training Required:
a. Three (3) years experience working in a managed healthcare or home infusion environment, with working knowledge of clinical utilization management guidelines and medical benefit and specialty drugs, include two (2) years working knowledge of Medicare.

3. Other Skills, Competencies and Qualifications:
a. Read, Analyze and interpret primary medical literature, government regulations, CMS memos, general business periodicals, professional journals, technical procedures, standards and specifications.
b. Apply principles of logical thinking to define problems, collect data, establish facts, draw valid conclusions and prepare recommendations
c. Efficient in Microsoft Word, Excel, Outlook, and PowerPoint.
d. Effective interface with all staff levels
e. Organize and manage time to accurately complete tasks within designated time frames in a fast-paced environment.
f. Maintain current knowledge of and comply with regulatory and company policies and procedures.
g. Maintain confidentiality of member health and business information.
h. Ability to adjust work hours to meet business demands.
i. Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity

4. Level of Physical Demands:
a. Be able to sit and/or stand for prolonged periods of time
b. Manual dexterity to operate computer, phone and standard office machines

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: One location

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