Information Technology Jobs in Orange, OH
276 positions found — Page 4
D
Oncology-Medical Oncology Physician - $400,000 - $600,000/yearly
🏢 DocCafe
Salary not disclosed
DocCafe has an immediate opening for the following position: Physician - Oncology-Medical Oncology in West Orange, New Jersey.
Make $400,000 - $600,000/yearly.
DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.
----------------
Register now to apply for this job and for access to 120,000+ other openings.
DocCafe Offers:
- Free Physician and Advanced Practice Job Search:Easily search, review and apply to jobs that meet your requirements. Plus, set up e-mail alerts for when new jobs are added that meet your search criteria.
- Professional Profile:Attract employers with a profile page that includes your CV, credentials and other medical professional information.
- Confidentiality:Decide which information you want to share and when you appear in an employer's search results.
- Career Matching Support:Our experienced team can match you to your dream based on your unique preferences.
Get started with DocCafe today.
Not Specified
D
Cardiology Nurse Practitioner - Competitive Salary
✦ New 🏢 DocCafe
Salary not disclosed
DocCafe has an immediate opening for the following position: Nurse Practitioner - Cardiology in Orange, California.
DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.
----------------
Register now to apply for this job and for access to 120,000+ other openings.
DocCafe Offers:
- Free Physician and Advanced Practice Job Search:Easily search, review and apply to jobs that meet your requirements. Plus, set up e-mail alerts for when new jobs are added that meet your search criteria.
- Professional Profile:Attract employers with a profile page that includes your CV, credentials and other medical professional information.
- Confidentiality:Decide which information you want to share and when you appear in an employer's search results.
- Career Matching Support:Our experienced team can match you to your dream based on your unique preferences.
Get started with DocCafe today.
Not Specified
D
Family Practice/Primary Care Nurse Practitioner - $130,000 - $180,000/yearly
✦ New 🏢 DocCafe
Salary not disclosed
DocCafe has an immediate opening for the following position: Nurse Practitioner - Family Practice/Primary Care in Orange, California.
Make $130,000 - $180,000/yearly.
DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.
----------------
Register now to apply for this job and for access to 120,000+ other openings.
DocCafe Offers:
- Free Physician and Advanced Practice Job Search:Easily search, review and apply to jobs that meet your requirements. Plus, set up e-mail alerts for when new jobs are added that meet your search criteria.
- Professional Profile:Attract employers with a profile page that includes your CV, credentials and other medical professional information.
- Confidentiality:Decide which information you want to share and when you appear in an employer's search results.
- Career Matching Support:Our experienced team can match you to your dream based on your unique preferences.
Get started with DocCafe today.
Not Specified
D
Family Practice/Primary Care Physician Assistant - $115,000 - $130,000/yearly
✦ New 🏢 DocCafe
Salary not disclosed
DocCafe has an immediate opening for the following position: Physician Assistant - Family Practice/Primary Care in Port Orange, Florida.
Make $115,000 - $130,000/yearly.
DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.
----------------
Register now to apply for this job and for access to 120,000+ other openings.
DocCafe Offers:
- Free Physician and Advanced Practice Job Search:Easily search, review and apply to jobs that meet your requirements. Plus, set up e-mail alerts for when new jobs are added that meet your search criteria.
- Professional Profile:Attract employers with a profile page that includes your CV, credentials and other medical professional information.
- Confidentiality:Decide which information you want to share and when you appear in an employer's search results.
- Career Matching Support:Our experienced team can match you to your dream based on your unique preferences.
Get started with DocCafe today.
Not Specified
D
Hematology/Oncology Physician Assistant - Competitive Salary
✦ New 🏢 DocCafe
Salary not disclosed
DocCafe has an immediate opening for the following position: Physician Assistant - Hematology/Oncology in Orange City, Florida.
DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.
----------------
Register now to apply for this job and for access to 120,000+ other openings.
DocCafe Offers:
- Free Physician and Advanced Practice Job Search:Easily search, review and apply to jobs that meet your requirements. Plus, set up e-mail alerts for when new jobs are added that meet your search criteria.
- Professional Profile:Attract employers with a profile page that includes your CV, credentials and other medical professional information.
- Confidentiality:Decide which information you want to share and when you appear in an employer's search results.
- Career Matching Support:Our experienced team can match you to your dream based on your unique preferences.
Get started with DocCafe today.
Not Specified
D
Pediatrics Nurse Practitioner - $141,000 - $233,000/yearly
✦ New 🏢 DocCafe
Salary not disclosed
DocCafe has an immediate opening for the following position: Nurse Practitioner - Pediatrics in Orange, California.
Make $141,000 - $233,000/yearly.
DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.
----------------
Register now to apply for this job and for access to 120,000+ other openings.
DocCafe Offers:
- Free Physician and Advanced Practice Job Search:Easily search, review and apply to jobs that meet your requirements. Plus, set up e-mail alerts for when new jobs are added that meet your search criteria.
- Professional Profile:Attract employers with a profile page that includes your CV, credentials and other medical professional information.
- Confidentiality:Decide which information you want to share and when you appear in an employer's search results.
- Career Matching Support:Our experienced team can match you to your dream based on your unique preferences.
Get started with DocCafe today.
Not Specified
A
Jr. AI/ML Engineer
Salary not disclosed
About Us:
Astiva Health, Inc., located in Orange, CA is a premier health plan provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
SUMMARY:
We are seeking a skilled and adaptable Junior AI/ML Engineer to join our fast-moving team building impactful AI solutions in healthcare. Our work focuses on extracting and interpreting data from unstructured medical documents, improving clinical coding accuracy, streamlining administrative processes, and enhancing patient outreach.
Projects will evolve rapidly, from fine-tuning large language models (LLMs) on specialized medical PDFs, to optimizing OCR pipelines in Azure, and new challenges emerge regularly. This role suits someone who thrives in ambiguity, enjoys hands-on model development, and wants to directly influence healthcare delivery through applied AI/ML.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
- Design, fine-tune, and optimize large language models (LLMs) and multimodal models for healthcare-specific NLP tasks, such as information extraction, classification, and summarization from clinical documents (e.g., medical charts, patient files, scanned forms).
- Develop and improve document understanding pipelines, including fine-tuning OCR / layout-aware models (especially in cloud environments like Azure AI, Azure Foundry) to handle real-world variability in medical forms, handwriting, and scanned PDFs.
- Build and iterate on end-to-end ML solutions that transform unstructured healthcare data into structured, actionable insights
- Collaborate closely with clinicians, product managers, data annotators, and engineers to define problems, curate/annotate datasets, evaluate model performance against clinical and business metrics, and iterate quickly.
- Deploy models into production environments (cloud-based inference, batch processing, or API endpoints) with attention to latency, cost, scalability, and healthcare compliance considerations (HIPAA, data privacy).
- Stay current with advancements in LLMs, vision-language models, efficient fine-tuning techniques (LoRA/QLoRA, PEFT), RAG, multimodal AI, and domain-specific healthcare AI research.
- Contribute to a culture of rapid prototyping, rigorous evaluation, and continuous improvement in a dynamic project landscape where priorities can shift based on new opportunities or stakeholder needs.
- Other duties as assigned
REQUIRED TECHNICAL SKILLS:
- Proficiency in Python and familiarity with common ML frameworks (e.g., PyTorch, TensorFlow, scikit-learn)
- Experience applying NLP techniques to unstructured text
- Hands-on experience working with LLMs, including:
- Prompt design and iteration
- Using pre-trained models for classification or extraction tasks
- Foundational understanding of model fine-tuning, such as:
- Fine-tuning transformer models or LLMs for classification or information extraction
- Adapting existing training scripts or examples to new datasets
- Familiarity with model evaluation metrics (precision, recall, F1) and basic error analysis
- Experience working with labeled datasets and annotation outputs, including reviewing label quality
- Understanding of common ML problem types, including binary and multi-label classification
- Awareness of model bias, label noise, and false positives, with the ability to discuss tradeoffs and mitigation strategies
- Basic understanding of production ML workflows (versioning, reproducibility, monitoring concepts)
OTHER SKILLS and ABILITIES:
- Hands-on fine-tuning experience with LLMs (e.g., Hugging Face, OpenAI fine-tuning, Azure Foundry), even if limited to small-scale or academic projects
- Exposure to cloud ML platforms (Azure ML, AWS SageMaker, or GCP)
- Familiarity with RAG architectures and retrieval-based grounding
- Experience with NLP libraries (spaCy, Hugging Face Transformers, NLTK)
- Introductory experience with weak supervision or noisy-label learning
- Interest in healthcare or biomedical NLP
- Curiosity about knowledge graphs, ontologies, or structured prediction
- Familiarity with secure data handling practices
- Willingness and ability to learn workflows for sensitive or regulated data (e.g., HIPAA-covered healthcare data), including privacy-aware data handling and secure ML workflows
EXPERIENCE:
- Bachelor’s Degree in related field
- 1–2 years of experience in machine learning, applied NLP, or software engineering
- Demonstrated some experience training or fine-tuning ML models, not just using APIs
- Ability to collaborate with senior engineers and domain experts and incorporate feedback
BENEFITS:
- 401(k)
- Dental Insurance
- Health Insurance
- Life Insurance
- Vision Insurance
- Paid Time Off
- Free catered lunches
Not Specified
P
Manager in Training
Salary not disclosed
Do you have sales experience? Are you passionate about building relationships with potential and current residents? Keep reading, this job might be a perfect fit!
LOCATION: This position is required to be onsite full time at Eleven10 Apartment Homes, 1110 West Town and Country Road, Orange CA 92868. Weekend availability required
Who We Are: Picerne Residential is the property management division of The Picerne Group, which operates multi-family apartment communities across Southern California. Picerne Residential focuses on creating premium living experiences by providing exceptional customer service for all residents.
About the Position: The ideal candidate will be trained in day-to-day resident relations interaction with the goal of creating a sense of community and a highly sought-after resident lifestyle that supports retention and lease renewals. This role provides exposure to sales strategies, including prospecting, qualifying, and closing potential residents and then on executing a lease.
Candidates must meet all Picerne Residential hiring criteria and demonstrate a background compatible with The Picerne Group’s culture, goals, and values.
Key Position Responsibilities:
- Create and build a strong Picerne Resident experience brand that supports the sales team and builds exceptional resident relationships to encourage resident retention.
- Handle day-to-day resident relations tasks to provide a luxury lifestyle brand.
- Support the Sales team on the sales funnel as needed.
- Weekend availability required.
What You Bring:
- Current student or recent graduate of an academically reputable four-year college. Bachelor's Degree preferred
- Excellent interpersonal and communication skills
- Demonstrates developing emotional intelligence (EQ) and strong interpersonal awareness
- Empathetic and able to build genuine rapport with residents and prospects
- Solutions-oriented with a keen ability to problem-solve effectively
- Charismatic, confident, and comfortable engaging with a wide range of personalities
- Brings positive energy and a professional, customer-focused attitude to the workplace
What We Offer: Happy, healthy employees enhance our ability to assist our residents. That's why Picerne Residential strives to offer a competitive and robust benefits package to our team members!
- 401k retirement benefits with employer match
- Medical insurance
- Dental coverage
- Vision coverage
- Basic life coverage
- Paid vacation and sick leave
- 9 paid company holidays
Compensation:
- Competitive pay structure + commission offering total annual compensation of approximately $65,000-$68,000.
The Picerne Group is an Equal Opportunity, Affirmative Action employer. Minorities, women, veterans, and individuals with disabilities are encouraged to apply. To access the 'EEOC is The Law' Information poster please visit this website:
internship
C
Behavioral Health Utilization Management Medical Case Manager
Salary not disclosed
Behavioral Health Utilization Management Medical Case Manager
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Behavioral Health Utilization Management Medical Case Manager and help shape the future of healthcare where you'll be an integral part of our BHI ‐ BH Utilization Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for authorization and notification of behavioral health services from health professionals, clinical facilities and ancillary providers. You will be responsible for prior authorizations, concurrent review and related processes. You will utilize CalOptima Health's medical criteria, policies and procedures to authorize referral requests from behavioral health professionals, clinical facilities and ancillary providers. You will directly interact with providers and facilities and serve as a resource for their needs. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 85% ‐ Utilization Management Services
- Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.
- Reviews requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request.
- Responsible for mailing rendered decision notifications to the provider and member, as applicable.
- Screens inpatient and outpatient requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow‐up in the utilization management system.
- Completes the required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates.
- Contacts the health networks and/or CalOptima Health Customer Service regarding health network enrollments.
- Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or through verbal communication if the issue is of an urgent nature.
- Refers cases of possible over/under utilization to the Medical Director for proper reporting.
- Completes care coordination activities as related to Transition Care Management (TCM) activities.
- Reviews International Classification of Diseases (ICD‐10), Current Procedural Terminology (CPT‐4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and the existence of coverage specific to the line of business.
- 10% ‐ Administrative Support
- Assists manager with identifying areas of staff training needs and maintains current data resources.
- Complies with data tracking protocols.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN and related required education PLUS 3 years of clinical experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
You'll Stand Out More If You Possess the Following:
- Utilization management reviewer experience.
- Managed care experience.
- Behavioral health clinical experience.
What the Regulatory Agencies Need You to Possess?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN.
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role.
- Our current hiring range is: Pay Grade: 313 ‐ $90,820 ‐ $145,312 ($43.66 ‐ $69.8615).
- The final salary offered will be based on education, job‐related knowledge and experience, skills relevant to the role and internal equity among other factors.
- This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**)
- A
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a Behavioral Health Utilization Management Medical Case Manager and help shape the future of healthcare where you'll be an integral part of our BHI ‐ BH Utilization Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.
- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for authorization and notification of behavioral health services from health professionals, clinical facilities and ancillary providers. You will be responsible for prior authorizations, concurrent review and related processes. You will utilize CalOptima Health's medical criteria, policies and procedures to authorize referral requests from behavioral health professionals, clinical facilities and ancillary providers. You will directly interact with providers and facilities and serve as a resource for their needs. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
- 85% ‐ Utilization Management Services
- Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.
- Reviews requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request.
- Responsible for mailing rendered decision notifications to the provider and member, as applicable.
- Screens inpatient and outpatient requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow‐up in the utilization management system.
- Completes the required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates.
- Contacts the health networks and/or CalOptima Health Customer Service regarding health network enrollments.
- Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or through verbal communication if the issue is of an urgent nature.
- Refers cases of possible over/under utilization to the Medical Director for proper reporting.
- Completes care coordination activities as related to Transition Care Management (TCM) activities.
- Reviews International Classification of Diseases (ICD‐10), Current Procedural Terminology (CPT‐4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and the existence of coverage specific to the line of business.
- 10% ‐ Administrative Support
- Assists manager with identifying areas of staff training needs and maintains current data resources.
- Complies with data tracking protocols.
- 5% ‐ Other
- Completes other projects and duties as assigned.
Do You Have What the Role Requires?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN and related required education PLUS 3 years of clinical experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
You'll Stand Out More If You Possess the Following:
- Utilization management reviewer experience.
- Managed care experience.
- Behavioral health clinical experience.
What the Regulatory Agencies Need You to Possess?
- Current California unrestricted license such as LCSW, LPCC, LMFT or RN.
Your Knowledge & Abilities to Bring to this Role:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role.
- Our current hiring range is: Pay Grade: 313 ‐ $90,820 ‐ $145,312 ($43.66 ‐ $69.8615).
- The final salary offered will be based on education, job‐related knowledge and experience, skills relevant to the role and internal equity among other factors.
- This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**)
- A
Not Specified
A
Pharmacy Technician - Hybrid (Orange, CA)
✦ New
Salary not disclosed
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Pharmacy Technician performs department administrative functions that do not require the Pharmacy Managers judgment. Responsible for the administrative and clerical support directly involved with the day-to-day operations of the multiple programs performed by the department. Performs assigned tasks to meet AHP HMO and Pharmacy Department goals.
General Duties/Responsibilities
Job Requirements:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1 While performing the duties of this job, the employee is regularly required to talk, hear, and sit; use hands to manipulate office equipment.
2 The employee regularly is required to stand, walk, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
3 The employee frequently lifts and/or moves up to 10 pounds.
4 Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $41,472.00 - $62,208.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
Remote working/work at home options are available for this role.
The Pharmacy Technician performs department administrative functions that do not require the Pharmacy Managers judgment. Responsible for the administrative and clerical support directly involved with the day-to-day operations of the multiple programs performed by the department. Performs assigned tasks to meet AHP HMO and Pharmacy Department goals.
General Duties/Responsibilities
- Assists with the daily operations of the various Pharmacy Department programs, multiple projects and participate in Plan and regulatory agency audits, as necessary.
- Makes high volume of outbound calls to members, prescribers, and pharmacies in regard to the Adherence program.
- Assists members in refilling their medications and reaching out to the prescriber’s office if a member requires additional refills on their maintenance medications.
- Drafts routine reports and correspondence.
- Supports all CMS required oversight processes of PBM including but not limited to: Rebates, Explanation of Benefit reports, Transition Reports, and Part B vs Part D.
- Responds to inquiries from physicians, members, and pharmacies related to formulary and prescription benefits.
- Retrieves accurate, concise, applicable, and timely drug information.
- Interacts with Plan's contracted PBM to ensure communications and information to other internal Plan departments as applicable.
- Interacts with Plan’s contracted PBM in regard to Prior Authorizations, Overrides and in resolving issues pertaining to member’s medications.
- Makes outbound calls to pharmacies and prescribers to resolve prescription issues such as medication requires Prior Authorization, assist retail/mail order pharmacies in resolving third party rejections, and reviewing daily rejections while ensuring we are CMS compliant.
- Interacts with internal plan departments to address pharmacy related issues.
- Works closely with compliance department to make sure Pharmacy Programs meet the criteria established by CMS.
- Ensures all HMO’s members information is kept confidential according to HIPAA.
- Other duties as assigned.
Job Requirements:
- Required: Minimum 1 year customer experience.
- Preferred: Prior Pharmacy Tech experience in a healthcare setting.
- Required: High School Diploma or GED.
- Preferred: Associates Degree in Pharmacy Tech
- Required: None
- Preferred: Pharmacy Tech school
- Required:
- Knowledge of pharmacy and medical nomenclature/terminology, common medication dosages, trade & generics, and medication therapy application.
- Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
- Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
- Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
- Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
- Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
- Preferred: Bilingual - English/Spanish or English/Chinese
- Required: Pharmacy Tech license
- Preferred: Certified Pharmacy Technician
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1 While performing the duties of this job, the employee is regularly required to talk, hear, and sit; use hands to manipulate office equipment.
2 The employee regularly is required to stand, walk, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
3 The employee frequently lifts and/or moves up to 10 pounds.
4 Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $41,472.00 - $62,208.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
- DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email
Remote working/work at home options are available for this role.
Not Specified
jobs by
✓ All jobs loaded