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Remote Pbm Business Analyst Jobs in Texas (NOW HIRING)

Amer Technology

Business Analyst

Austin, TX · Remote

Note - This position is remote; however, candidates must currently reside within Texas. (Out-of ... This role will serve as the Lead WIC Business Analyst responsible for leading business and gap ...

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Remote Pbm Business Analyst information

What are the key skills and qualifications needed to thrive as a Remote PBM Business Analyst, and why are they important?

To thrive as a Remote PBM Business Analyst, you need strong analytical skills, experience in pharmacy benefit management (PBM), and a relevant degree such as in healthcare, business, or information systems. Familiarity with PBM software platforms, claims processing systems, and proficiency in data analysis tools like SQL or Excel are typically required. Excellent communication, problem-solving abilities, and self-motivation are crucial soft skills for collaborating remotely and translating complex data into actionable insights. These competencies ensure effective analysis and optimization of PBM processes, contributing to improved healthcare outcomes and organizational efficiency.

How does a Remote PBM Business Analyst typically collaborate with cross-functional teams to drive project success?

A Remote PBM (Pharmacy Benefit Management) Business Analyst frequently works with diverse teams including IT, pharmacy operations, clinical staff, and client services. Collaboration is often facilitated through virtual meetings, shared project management tools, and regular status updates. Analysts are responsible for gathering requirements, clarifying project goals, and translating business needs into technical solutions, ensuring effective communication across departments. Building strong relationships and maintaining clear documentation are key to overcoming the challenges of remote teamwork and ensuring project milestones are met efficiently.

What does a Remote PBM Business Analyst do?

A Remote PBM (Pharmacy Benefit Management) Business Analyst is responsible for analyzing and optimizing pharmacy benefit programs for healthcare organizations while working remotely. They use data analytics to evaluate drug utilization, cost trends, and pharmacy claims, and recommend improvements in benefit design or operational processes. Their role often involves collaborating with cross-functional teams, interpreting regulatory requirements, and ensuring PBM services align with organizational goals. Additionally, they may help implement new PBM programs, monitor performance metrics, and support reporting and compliance activities.

What is the difference between Remote Pbm Business Analyst vs Remote Pbm Data Analyst?

AspectRemote Pbm Business AnalystRemote Pbm Data Analyst
Required CredentialsBachelor's in Business, Healthcare, or related field; certifications like CBAP or CCBABachelor's in Data Science, Statistics, or related; certifications like CAP or Microsoft Data certifications
Work EnvironmentCollaborates with business teams, stakeholders, and project managers in healthcare or pharmacy benefit managementFocuses on data collection, analysis, and reporting within healthcare or pharmacy sectors
Employer & Industry UsageUsed by healthcare insurers, pharmacy benefit managers, and healthcare providersUtilized by healthcare organizations, insurers, and analytics firms in pharmacy benefit management

The Remote Pbm Business Analyst primarily bridges business needs with IT solutions, focusing on process improvements and stakeholder communication. In contrast, the Remote Pbm Data Analyst concentrates on analyzing healthcare data to inform decisions. Both roles often work in healthcare and pharmacy benefit management industries, but their core responsibilities differ—business analysis versus data analysis.

What are the most commonly searched types of Pbm Business Analyst jobs in Texas? The most popular types of Pbm Business Analyst jobs in Texas are:
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What job categories do people searching Remote Pbm Business Analyst jobs in Texas look for? The top searched job categories for Remote Pbm Business Analyst jobs in Texas are:
What cities in Texas are hiring for Remote Pbm Business Analyst jobs? Cities in Texas with the most Remote Pbm Business Analyst job openings:
Remote Pbm Business Analyst jobs near you
Remote PBM Pharmacist

Remote PBM Pharmacist

A-Line Staffing Solutions

Austin, TX • Remote

$53/hr

Full-time

Retirement

This job post has expired today. Applications are no longer accepted.

Job description

-Line Staffing is now hiring Clinical Pharmacist – Prior Authorization / Medicare (Remote) in United States. The Clinical Pharmacist would be working for a Fortune 500 healthcare company and has career growth potential. This would be full time / 40+ hours per week.

Clinical Pharmacist – Prior Authorization / Medicare Compensation

  • The pay for this position is $53.00 per hour
  • Benefits are available to full-time employees after 90 days of employment
  • A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates

Clinical Pharmacist – Prior Authorization / Medicare Highlights

This position is a contract assignment with potential to hire on permanently based upon attendance, performance, and business needs

The required availability for this position is:

  • Training: Monday – Friday, 9:00 AM – 5:30 PM EST (first 8 weeks, no time off permitted)
  • Post-Training:
    • Shifts between 7:00 AM – 8:00 PM EST (Mon–Fri)
    • 7:00 AM – 4:30 PM EST (Sat–Sun)
    • Includes weekend rotation or 1 weekend day

Clinical Pharmacist – Prior Authorization / Medicare Responsibilities

  • Review and process prior authorizations, coverage determinations, and Medicare appeals
  • Evaluate clinical documentation to support approval/denial decisions
  • Ensure compliance with CMS and Medicare Part D guidelines and timelines
  • Perform outbound provider outreach to obtain additional clinical information
  • Accurately document all case activity in internal systems
  • Meet productivity and quality standards in a high-volume environment
  • Utilize drug compendia and clinical guidelines for decision-making

Clinical Pharmacist – Prior Authorization / Medicare Requirements

  • Active Pharmacist (RPh) license in state of residence (must be in good standing)
  • Bachelor's Degree in Pharmacy or PharmD
  • Strong computer skills (Excel and Word required)
  • Ability to work independently in a remote, productivity-driven environment
  • Experience with data entry and navigating multiple systems/screens
  • Dedicated, quiet workspace for remote work
  • Wired internet connection (minimum 25 Mbps download / 5 Mbps upload)
  • Ability to sit and focus for the duration of the shift

High School Diploma or GED

  • Attendance is mandatory for the first 90 days

Clinical Pharmacist – Prior Authorization / Medicare Preferred Qualifications

  • Prior experience in Managed Care or PBM environment
  • Experience with prior authorizations, appeals, or coverage determinations
  • Medicare Part D knowledge
  • Previous remote or production-based pharmacist experience
  • Knowledge of Access, PowerPoint, and Visio

If you think this Clinical Pharmacist – Prior Authorization / Medicare (Remote) position is a good fit for you, please reach out to me – feel free to call, e-mail, or apply to this posting!

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About A-Line Staffing Solutions

Sourced by ZipRecruiter

A-Line Staffing Solutions is an established full-service recruiting and staffing provider that operates in the industry of human resources and recruitment. Based in Utica, Michigan, A-Line Staffing Solutions has been committed to its mission of providing innovative and effective workforce solutions since its foundation. The company specializes in providing high-quality staffing solutions for a range of disciplines, including Information Technology, Professional, Administrative, Healthcare, and more. A-Line prides itself on its ability to offer comprehensive and tailored staffing solutions in line with the varying needs of different businesses, which has played a crucial role in the company's growth and success.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Utica, MI, US

Year founded

2004

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