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Remote Pbm Jobs in Ohio (NOW HIRING)

Bcbsa

Director, Trade Client Relations

Delaware, OH · On-site +1

$155K - $175K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...

Bcbsa

Director, Trade Client Relations

New Hampshire, OH · On-site +1

$155K - $175K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...

Bcbsa

Director of Audit - Synergie (Remote)

New Hampshire, OH · Remote

$150K - $200K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... plan or PBM. * Strong experience managing external audit vendors during audits * Strong ... The compensation for this role is budgeted between $150,000 and $200,000. #LI-Remote This is the ...

Fuze Health

Verification Pharmacist - FuzeRx

Sharonville, OH · On-site +1

$53.50 - $64.25/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Previous experience with PV1, order entry verification, centralized pharmacy verification, or remote pharmacist workflows. * Experience in health-system, specialty, mail-order, or PBM pharmacy ...

All JobsPbm JobsRemote Pbm JobsRemote Pbm Jobs in Ohio

Remote Pbm information

What is a remote PBM?

Remote PBMs, or Remote Pharmacy Benefit Managers, are professionals who manage prescription drug benefits for health plans, employers, and other groups from a remote location. They are responsible for ensuring that members receive appropriate, cost-effective medications while balancing the needs of both patients and payers. Remote PBMs work with pharmacies, insurance companies, and healthcare providers to process claims, negotiate pricing, and implement drug formulary policies. This role can be performed from home or other off-site locations using secure digital tools and platforms.

What are the key skills and qualifications needed to thrive as a remote Pharmacy Benefit Manager (PBM), and why are they important?

To thrive as a Remote Pharmacy Benefit Manager (PBM), you need a strong background in pharmacy, healthcare administration, or a related field, often supported by relevant degrees or certifications. Familiarity with pharmacy benefit management software, claims processing systems, and data analytics tools is typically required. Exceptional attention to detail, analytical thinking, and effective communication are crucial soft skills for collaborating with stakeholders and resolving complex issues remotely. These skills ensure accurate benefit administration, regulatory compliance, and positive outcomes for clients and patients in a remote work environment.

What are some common challenges faced by remote PBM professionals, and how can they be addressed?

Remote PBM professionals often encounter challenges such as maintaining effective communication with team members, staying updated on regulatory changes, and managing sensitive health information securely. To address these, it's important to leverage collaboration tools, participate in regular virtual meetings, and stay engaged with ongoing training. Additionally, adhering to best practices for data privacy and fostering strong relationships with both clients and pharmacies can help ensure smooth operations and job satisfaction.

What is the difference between Remote Pbm vs Remote Pharmacovigilance Associate?

AspectRemote PbmRemote Pharmacovigilance Associate
Required CredentialsPharmacy or healthcare background, certifications like CPR or pharmacy licenseHealthcare degree, certifications in pharmacovigilance or drug safety
Work EnvironmentRemote, healthcare or pharmacy settingsRemote, pharmaceutical or biotech companies
Industry UsagePharmacy, healthcare providers, clinical settingsPharmaceutical industry, drug safety departments
Common Search/ComparisonRemote Pbm vs Remote Pharmacovigilance Associate

Remote Pbm roles focus on pharmacy benefit management, involving healthcare and insurance processes, while Remote Pharmacovigilance Associate positions are centered on drug safety and monitoring adverse effects in the pharmaceutical industry. Both roles are remote, require healthcare-related credentials, and are used within healthcare and pharma sectors, but they serve different functions within the industry.

More about Remote Pbm jobs

What are the most commonly searched types of Pbm jobs in Ohio?

The most popular types of Pbm jobs in Ohio are:

What are popular job titles related to Remote Pbm jobs in Ohio?

For Remote Pbm jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Remote Pbm jobs in Ohio look for?

The top searched job categories for Remote Pbm jobs in Ohio are:

What cities in Ohio are hiring for Remote Pbm jobs?

Cities in Ohio with the most Remote Pbm job openings:

Remote Pbm jobs near you
Infographic showing various Remote Pbm job openings in Ohio as of August 2026, with employment types broken down into 92% Full Time, and 8% Contract. Highlights an 100% Remote job distribution.

Pharmacy Billing Manager

Communicarehealth

Broadview Heights, OH • Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 29 days ago

Job description

Job Address:

9299 Market Place Broadview Heights, OH 44147


Pharmacy Billing Manager
Job Type: Full-Time - Remote - Pharmacies: West Virginia, Ohio, Indiana and Maryland
Position Overview:
Manage the day to day operation of the billing unit for each pharmacy. Manage and update patient accounts to ensure consistent billing processes for all payers as outlined in the pharmacy billing manual. Help manage the pharmacy credentialing process for various PBM insurance payers (Med D, Managed Medicaid, commercial, ect.) for each PSG pharmacy location.
Key Responsibilities:

  • Manage the day to day operations of the billing team
  • Ensure that all billing processes are followed as outline in the billing manual to ensure consistency and prescription integrity for compliance
  • Maintain all current patient accounts by verifying, adding or editing current insurance (Medicare Part D, Commercial, Medicaid, Medicare A and Managed Care)
  • Works closely with the facility business office managers for Medicare Part D insurance plans and Census clarifications
  • Works directly with several hospice plans and third party plans as needed.
  • Review the setup of SQL reporting to ensure that all charges are billed appropriate as outlined in the billing manual
  • Manage the pharmacy credentialing process for PBM insurance payers (Medicare Part D, Commercial, Medicaid, Medicare A and Managed Care) for each PSG pharmacy location
  • Ensure all pharmacies are actively credentialed/re-credentialed with PBM insurance payers
  • Any other assigned duties assigned
  • Follow federal and state regulations
  • Adhere to company policies and procedures
  • Follow HIPPA guidelines and regulations

Qualifications:

  • Management of a Team of employees a plus (but not required)
  • Previous Long-Term Care pharmacy experience a plus (but not required)
  • Knowledge of Framework LTC a plus (but not required)
  • Experience in Pharmacy insurance payer credentialing (LTC pharmacy experience preferred)

Salary and Benefits:

  • Competitive salary commensurate with experience
  • Comprehensive benefits package, including health, dental, and vision insurance, 401(k) with company match, paid time off, and more

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