6 Healthcare Providers jobs in Guaynabo

Job Description

Job Description

The Patient Care Technician is responsible for supporting Farmacias Plaza patients with on-time medication refills for the conditions included in the Centers for Medicare and Medicaid (CMS) STARs Program, currently Cholesterol, High Blood Pressure, and oral Diabetes, as well as other conditions and Health Plans as assigned. Each Pharmacy Benefits Manager (PBM) and Managed Care Organization (MCO) provide unique tools and programs for pharmacies that are tailored to meet the needs of their members. Adherence-based oversee topics may include on-time refills, expiring prescriptions, 90-day conversions, medication synchronization, barriers to adherence, STARS delivery, will- call bin monitoring, among other

Other Responsibilities:

• Balance inbound and outbound calls continuously throughout the workday.

• Achieve call resolution on topics not requiring a pharmacist intervention.

• Refer patients and situations to a pharmacist as required.

• Coordinate the delivery of medications to the patient’s home or preferred location.

• Use Pharmacy System, currently PrimeRx, to conduct research necessary prior to and during patient calls; process/reverse claims as necessary.

Required:

• Associate degree in pharmacy technician

• Pharmacy Technician License

• Registration Certificate

*Equal Opportunity Employer M/F/V/D*

Job Description

Job Description

The Patient Care Technician is responsible for supporting Farmacias Plaza patients with on-time medication refills for the conditions included in the Centers for Medicare and Medicaid (CMS) STARs Program, currently Cholesterol, High Blood Pressure, and oral Diabetes, as well as other conditions and Health Plans as assigned. Each Pharmacy Benefits Manager (PBM) and Managed Care Organization (MCO) provide unique tools and programs for pharmacies that are tailored to meet the needs of their members. Adherence-based oversee topics may include on-time refills, expiring prescriptions, 90-day conversions, medication synchronization, barriers to adherence, STARS delivery, will- call bin monitoring, among other

Other Responsibilities:

• Balance inbound and outbound calls continuously throughout the workday.

• Achieve call resolution on topics not requiring a pharmacist intervention.

• Refer patients and situations to a pharmacist as required.

• Coordinate the delivery of medications to the patient’s home or preferred location.

• Use Pharmacy System, currently PrimeRx, to conduct research necessary prior to and during patient calls; process/reverse claims as necessary.

Required:

• Associate degree in pharmacy technician

• Pharmacy Technician License

• Registration Certificate

*Equal Opportunity Employer M/F/V/D*

**Shift- Monday- Friday 8:30 am - 5:00 pm PST - or as business needs dictate -remote**
**_What Customer Service Operations contributes to Cardinal Health_**
Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution.
Customer Service Operations is responsible for providing outsourced services to customers relating to medical billing, medical reimbursement, and/or other services by acting as a liaison in problem-solving, research and problem/dispute resolution
**_Job Summary_**
The Representative II, Customer Service Operations processes orders for distribution centers and other internal customers in accordance to scheduling, demand planning and inventory. The Representative II administers orders in internal systems and responds to customer questions, clearly communicating delays, issues and resolutions. This job also processes non-routine orders, such as product samples, and ensures that special requirements are included in an order.
This position specializes in new patient care on the customer service team.
**_Responsibilities_**
+ Processes routine customer orders according to established demand plans, schedules and lead times using SAP and other internal systems. Enters all necessary order information, reviews order contents, and ensures that orders are closed once completed.
+ Responds to inquiries from internal customers, such as Distribution Centers, regarding order tracking information as well as on-hold, back order and high priority statuses.
+ Identifies and communicates resolutions to order delays, missing information, and product availability based on customer profiles.
+ Uses dashboards and reporting from internal systems to identify causes of order issues, such as lack of inventory or invalid measures or requirements in the order. Creates visuals and conducts analyses as necessary to understand and communicate order data and issues.
+ Coordinates with a variety of internal stakeholders, including Planners and externally facing Customer Service Representatives, regarding customer issues.
+ For international shipping and in cases of special-order requirements, coordinates with Quality and Global Trade teams in order to ensure compliance of orders.
+ Processes orders for product samples and trials, coordinating with Marketing teams as necessary to understand the purpose and requirements of the samples.
**_Qualifications_**
+ 1-3 years of experience, preferred
+ High School Diploma, GED or equivalent work experience, preferred
**_What is expected of you and others at this level_**
+ Applies acquired job skills and company policies and procedures to complete standard tasks
+ Works on routine assignments that require basic problem resolution
+ Refers to policies and past practices for guidance
+ Receives general direction on standard work; receives detailed instruction on new assignments
+ Consults with supervisor or senior peers on complex and unusual problems
.
**Anticipated hourly range:** $15.75 per hour -$18.50 per hour
**Bonus eligible:** No
**Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being
+ Medical, dental and vision coverage
+ Paid time off plan
+ Health savings account (HSA)
+ 401k savings plan
+ Access to wages before pay day with myFlexPa _y_
+ Flexible spending accounts (FSAs)
+ Short- and long-term disability coverage
+ Work-Life resources
+ Paid parental leave
+ Healthy lifestyle programs
**Application window anticipated to close:** 08/28/2025 *if interested in opportunity, please submit application as soon as possible.
The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (

**Become a part of our caring community and help us put health first**
The Senior Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement formulary and medical strategies for the Medicaid line of business. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
The Senior Formulary Operations Management Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement formulary and medical strategies for the Medicaid line of business.
+ Utilizes broad understanding of pharmacy, managed care, PBM, market and regulatory insights to support the implementation of formulary and medical strategies to mitigate Humana's costs and trend while improving our member's health outcomes and costs.
+ Performs formulary and medical drug list analysis and reporting that assist in the decision making of Medicaid drug strategies.
+ Works across multiple departments to support Medicaid drug list changes for member communications (monthly, quarterly, and ad-hoc).
+ Prepares presentations to executive-level audiences on our Medicaid strategies.
+ Works with appropriate business partners to ensure accurate and timely implementation of formulary and medical strategies.
+ Ensures Humana's business processes are compliant with state Medicaid contracts and provides appropriate attestation and evidence for audits and accreditation.
+ Develops key performance indicators and plans to drive overall process improvements and efficiency for the Medicaid line of business.
+ Serves as a key representative for Medicaid strategies across the organization.
+ Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
+ Drives for standardization and transparency with an aggressive focus on process documentation.
**Key Competencies:**
+ **Acts** **Strategically** : Has vision, anticipates future consequences and trends accurately; has broad knowledgeand perspective; createscompetitive and breakthrough strategies and plans.
+ **Builds Trust** : You honor your word by doingwhat you say you are going to do.
+ **Drives for Excellence** : You are a continuouslearner who encouragesothers to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
+ **Innovates** :Introduces or develops new ideasand processes whichimprove performance or productivity.
+ **Implementation/Execution** : You are good at organizing and managing multiple priorities and/or projects by usingappropriatemethodologies and tools.
+ **Problem** **Solving** : You are a problem solver with the ability to encourage others incollaborativeproblemsolving.Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
**Use your skills to make an impact**
Required Qualifications:
+ Bachelor's degree or equivalent
+ 3+ years of experience in managed care or other pharmacy related field
+ 3+ years of experience of leading successful implementation of projects
+ 3+ years of technical experience required for data analysis and reporting
+ Experience in analysis and problem-solving
+ Excellent oral and written communication skills, previous experience presenting and interacting with senior leadership
+ Flexible, dynamic personality who works well in a team environment and is also an individual contributor
+ Ability to prioritize, organizes, and executes effective time management
+ Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
+ Ability to work in either a team or an individual capacity to achieve goals and meet deadlines
+ Successful track record in facilitating and consulting across teams and managing projects
+ Comprehensive knowledge of all Microsoft Office applications, including Excel, Word, Powerpoint, Project, and Visio.
**Preferred Qualifications:**
+ Master's degree
+ Knowledge of Medicaid business as it relates to pharmacy or medical drugs
+ Experience in finance and/or business-related pharmacy practice
+ Lean certification or Six Sigma Black belt
**Additional Information** :
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
**Work at home requirements:**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$86,300 - $118,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 09-04-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our

**Become a part of our caring community and help us put health first**
The Senior Inpatient Medical Coding Professional extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, PCS) to patient records. This position works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
**Responsibilities**
The Senior Inpatient Medical Coding Professional confirms appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information.
Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
+ Reviewing staff monthly QA review variances
+ Daily inventory monitoring and assignment of escalated inventory
+ Research on guidelines - CMS, AMA, etc.
+ Training new coders/auditors
+ Responsible for updating and maintaining processes/resources/guidelines in OneNote & Mentor
+ Point of contact for coders/auditors
+ Assist coders with coding or technical issues
+ Team Engagement
+ Assist with assignments as appropriate per leader direction
**Use your skills to make an impact**
**WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**WORK HOURS:** Typical work hours are Monday-Friday, 8 hours/day, 5 days/week. Start time is typically between 7AM-8AM EST.
Overtime might be offered but is not mandatory.
**Required Qualifications**
+ Experience with all of the following: Inpatient medical coding, analytics, health record security and privacy, HIPAA compliance, and data governance.
+ Hold at least one of the following AHIMA Coding Certifications: RHIT, RHIA, or CCS
+ Comprehensive knowledge of MS Word, Excel and PowerPoint
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ Experience implementing timely resolution to complex issues
**Preferred Qualifications**
+ Associate or Bachelor's degree
+ Previous leadership experience
**Additional Information**
**Work at Home Requirements**
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
**Interview Format**
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 08-31-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our