At SGS Consulting, we go beyond resume-job matches, creating meaningful connections and pathways for individuals to thrive in defining careers.
2025. All right reserved.
SGS_JOB_2602
Contract - 06+ Months
Location (mandatory): Hybrid in San Antonio, TX 78238 The Coverage Determination/ Appeals Service Representative I is responsible for working and triaging in the data entry related fax queues. The Representative I’s primary responsibilities will be to review each document with accuracy and place the case in the proper queues. Further responsibilities include research reports, maintaining complete, timely and accurate documentation of Coverage Determination/ Appeal requests and escalating issues to the Coverage Determination/Appeal pharmacists or management staff as needed. Position will require schedule flexibility including rotations through Nights, Weekends and Holiday Coverage.
Location (mandatory): San Diego, CA 92103 This position is responsible for dispensing prescriptions and coordinating clinical services for specialty drugs serviced at the branch location. This position is responsible for interacting with the health care professionals in the provision and coordination of customer care. Must also translate prescriptions, perform compounds and dispense prescribed pharmaceuticals. Must be comfortable communicating by telephone or mail, with patients and physicians for patient care. Will also be responsible for resolving orders via the EA (External Adjudication) queue.
Location (mandatory): Onsite in Lexington, SC 29072 Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning.
Location (mandatory): Onsite in Boston, MA 02115 Manages pharmacy workstations and tasks, supporting the team's ability to fill patient prescriptions, ensuring all medication needs and regulatory compliance standards are met for patients. National Certification PTCB or ExCPT
Location (mandatory): Onsite in Irmo, SC 29063 Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning.
Location (mandatory): Hybrid in Woonsocket, RI 02917 Provides various office and location support activities. Identifies, enhances, and follows specific processes and procedures to maximize the efficiencies of the business to which the support is being provided; ensures the correct functioning of facilities, office, and/or business support services.
Location (mandatory): Remote in EST Timezone This is a contract-focused role titled 'Senior Analyst,' but it is not an analytical role in the traditional sense. The primary responsibilities center around contract operations and negotiations, particularly within the 340B program. The Sr. Analyst, 340B Contract Operations is responsible for 340B Program contract facilitation. The role includes extensive collaboration with internal teams including Legal, Sales, Implementations, Account Management, etc. Duties include drafting and negotiating new and existing business contracts utilizing a contract management software, coordinating with various subject matter experts, and moderating Legal calls to see contracts through to completion. The Sr. Analyst, 340B Contract Operations will interact with several different areas to successfully issue agreements, resolve client comments within contracts, and seek successful execution with team as appropriate This role handles contract operations negotiations with clients and is not an analytical role
Location (mandatory): Remote in EST Timezone This role will focus on monitoring, troubleshooting, and resolving serialization and traceability exceptions, managing serialization and exception handling under the Drug Supply Chain Security Act (DSCSA). Assist in training Health teams (Retail pharmacies and distribution centers, PBM Mail, PBM Specialty, etc.) on serialization compliance, exception management, and best practices
Location (mandatory): Remote for Michigan or Indiana State candidates HEDIS Medical Record Review (MRR) Abstractor III "Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to the start of the assignment. This position interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and populates a data collection tool to support compliance with HEDIS and CMS performance measures. Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements. The candidate must be proficient with databases and with conducting 100% of work activities on the computer.
At SGS Consulting, we go beyond resume-job matches, creating meaningful connections and pathways for individuals to thrive in defining careers.