Arkansas Blue Cross and Blue Shield

Pharmacist

• Reports to and operates under the direction of Pharmacy Leadership
• Works cooperatively and sometimes independently with medical directors and enterprise personnel
• Assists in development of and supervises the drug utilization and prior authorization review program
• Contributes to and supports Enterprise-wide undertakings and commitments
• Develops and manages pharmacy cost containment strategies
• Develops and implements pharmacy cost containment strategies tailored to the enterprise, specific regions, and large accounts
• Drafts medical criteria and supports the enterprise prior authorization program
• Prepares and presents reports, data, and analyses on utilization and cost trends
• Provides leadership and advice on pharmacy reimbursement, claims processing policies and procedures, and pharmacy vendor selection
• Serves as a corporate pharmacy resource to medical management, operations, and sales staffs
• Serves as a liaison to pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers
• Uses clinical knowledge and independent critical thinking to interpret criteria, policies, and procedures and make determinations on prior approval and retrospective reviews
• Works with clinical and operations staff of pharmacy program vendors to ensure satisfactory service for members and providers

Clinical Pharmacist – Part-Time

Account Executive

• Serve as the executive liaison to national clients and nurture relationships with senior-level decision makers
• Develop multi-year strategic account plans tailored to client needs and industry trends
• Lead high-level client meetings to review performance and discuss strategic opportunities
• Drive contract renewal, upsell, and cross-selling opportunities
• Partner with product teams to introduce new offerings and enhance client value
• Lead renewal negotiations using a consultive and data-driven approach
• Guide internal account management, clinical, and operational teams on service commitments
• Advocate for clients while ensuring operational compliance and risk mitigation
• Monitor delivery metrics, resolve complex service issues, and identify process improvements
• Provide insight and counsel on healthcare policy, benefit trends, emerging healthcare trends, cost containment, and employee engagement
• Perform other job duties as assigned

Strategic Account Executive

Administration

• Design, deploy, maintain, enhance, operate, and manage development, test, and production environments for assigned systems
• Apply standard application design principles to create logical and physical application designs
• Consult with users to identify current operating procedures and clarify project objectives
• Deploy and test software upgrades, including maintaining test plans
• Follow corporate standards for naming conventions, security, and interface design
• Maintain project documentation in the designated tracking system
• Document changes to program code and scripts using appropriate commenting and software change documentation
• Write and update documentation describing software environments, implementations, and infrastructure

Workday Administrator

Analyst

• Analyze and respond to inquiries, complaints and/or concerns from members, providers, regulatory bodies and/or attorneys
• Communicate medical coverage policy, processing guidelines and policy language with internal and external sources to facilitate, resolve, and respond to appeals within URAC/legal timeframe
• Maintain administrative records of all case files, log appeals, and request relevant information from internal and external sources
• Maintain thorough knowledge of benefit plans
• Monitor the status of appeals
• Prepare written analysis communicating facts and determinations for appeal responses within the timeframe
• Recommend changes to the appeals process and contract language to minimize legal and regulatory liability
• Utilize current information from medical coding sources to ensure appeal guidelines are clear and concise
• Perform other duties as assigned

Appeal Analyst

Clinical Specialist

• Conduct telephonic care coordination and health coaching for members and families
• Identify preventive care, disease management, medication adherence, and other healthcare intervention opportunities
• Access appropriate health-related services and coordinate care with members, pharmacies, physicians, and providers
• Retrieve, abstract, and overread clinical medical records for HEDIS audit activities and quality-gap initiatives
• Ensure medical record review accuracy and compliance with CMS quality initiative guidelines
• Develop member work and progress plans based on member interactions and insights
• Help members schedule appointments and navigate the healthcare delivery system
• Identify and triage members to appropriate healthcare resources and resolve barriers to care
• Measure, analyze, and report HEDIS quality initiative results
• Create tools to capture and report information on member and provider quality-gap trends
• Create member and practitioner educational materials
• Assist with quality improvement initiatives
• Build relationships and serve as liaison and advocate among members, providers, health departments, and community organizations
• Perform provider outreach, including distributing gap reports and retrieving medical records
• Monitor gap closures and improvement activities with Stars Member Outreach Specialists, Stars Improvement Nurses, and health plan staff
• Perform other activities and projects as directed by Clinical Quality & HEDIS leadership

Government Programs Clinical Quality, HEDIS Specialist

Customer Support

• Answer the telephone switchboard and greet customers in a retail environment
• Assist the regional office team with administrative support functions serving internal and external customers and prospective customers
• Handle incoming faxes, reporting, database maintenance, member correspondence, inventory supplies and marketing materials
• Maintain orderly upkeep of the retail store, supply closet and hospitality area
• Assist customers with basic inquiries and needs, including processing payments, taking messages and directing calls
• Log service inquiries and document information relevant to contacts
• Schedule sales and service appointments for retail team members
• Conduct initial research of service inquiries and forward them for appropriate handling
• Make deliveries to postal services
• Perform other duties as assigned

Customer Support Specialist I

Manager

• Assess, plan, implement, coordinate, monitor, and evaluate options and services to meet individual health needs using plan benefits and community resources
• Facilitate cost effectiveness and cost containment measures
• Practice nursing within the scope of licensure and ensure compliance, appropriate level of care, and patient safety
• Provide specialized education and knowledge on disease-specific conditions
• Maintain current knowledge of medical and surgical procedures, products, healthcare services, drugs, healthcare delivery trends, enterprise procedures, policies, and contracts
• Serve as a liaison among patients, families/caregivers, physicians, hospital discharge planners, home care providers, and ancillary providers
• Work proactively with referrals to identify appropriate case management candidates, explain services, obtain voluntary agreement, and maintain a minimum patient caseload
• Perform other duties as assigned

RN Case Manager

• Assess, plan, implement, coordinate, monitor, and evaluate comprehensive care plans and services to meet individual health needs
• Use plan benefits and community resources to facilitate cost effectiveness and cost containment
• Practice nursing within the scope of licensure while ensuring compliance, appropriate level of care, and patient safety
• Provide specialized education on disease-specific conditions
• Maintain current knowledge of medical and surgical procedures, healthcare products and services, drugs, and healthcare delivery trends
• Serve as a liaison among patients, families/caregivers, physicians, hospital discharge planners, home care providers, and ancillary providers
• Work proactively with referrals to identify appropriate case management candidates
• Explain case management services, ensure voluntary agreement, and maintain a minimum patient caseload in a timely manner
• Perform other duties as assigned

• Assess, plan, implement, coordinate, monitor, and evaluate comprehensive care options and services for individual health needs
• Use plan benefits and community resources to promote cost effectiveness and cost containment
• Practice nursing within the scope of licensure and comply with policies, procedures, regulations, URAC standards, and state regulations
• Provide specialized education on disease-specific conditions
• Maintain current knowledge of medical and surgical procedures, healthcare products and services, drugs, and healthcare delivery trends
• Serve as a liaison among patients, families/caregivers, physicians, hospital discharge planners, home care providers, and ancillary providers
• Work proactively with referrals to identify appropriate case-management candidates
• Explain case-management services, obtain voluntary agreement, and maintain a minimum patient caseload in a timely manner
• Perform other duties as assigned

• Collaborate with internal stakeholders and vendors on system enhancements, upgrades, and new feature adoption
• Configure and support Epic Payer Platform applications to enable payer-provider interoperability
• Develop and maintain documentation, workflows, and training materials for end users
• Ensure timely and accurate data exchange supporting risk adjustment, care gap closure, quality measurement (e.g., HEDIS), and member longitudinal health records
• Evaluate system performance, monitor data quality and mapping, and identify opportunities to improve operational efficiency, reduce administrative burden, and enhance provider engagement
• Identify and implement process improvements
• Leverage reporting and analytics to monitor performance, identify trends, and support decision-making
• Monitor and ensure data quality, accuracy, and appropriate mapping across systems
• Partner with internal stakeholders, vendors, and provider teams to troubleshoot issues, support system enhancements, and drive adoption of Payer Platform capabilities
• Partner with providers to onboard, test, and optimize Payer Platform integrations and workflows
• Troubleshoot application, integration, and workflow issues across payer and provider environments

Clinical Pharmacist – Part-Time

Strategic Account Executive

Workday Administrator

Appeal Analyst

Government Programs Clinical Quality, HEDIS Specialist

Customer Support Specialist I

RN Case Manager

RN Case Manager

RN Case Manager

Payor Platform Applications Analyst