Supervises representatives, manages performance, and provides feedback through side-by-side and recorded call reviews.
Handles escalated calls, partners with business units, and coordinates team schedules to maximize efficiency.
Monitors volumes for pending queues and ensures timely processing of prior authorization forms.
PharMerica is a long-term care pharmacy services provider that supplies medications, clinical support, and pharmacy management to healthcare organizations across the United States. It operates as part of BrightSpring Health Services, combining personalized care with the resources of a national network.
Oversee daily clinical pharmacy functions including prior authorization reviews, override requests, and member/provider education calls.
Support staff training, quality improvement, and lead projects to optimize pharmacy operations and clinical outcomes.
Serve as a subject matter expert and make clinical decisions based on medical necessity and contract criteria.
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. It replaces fragmented systems with a unified claims processing platform and uses AI-powered care delivery to serve millions of Americans, fostering a mission-driven, collaborative culture.
Review prior authorization requests and make evidence-based decisions using clinical guidelines.
Ensure compliance with federal, state, and internal regulations while accurately documenting clinical decisions.
Provide clear, empathetic support to members, prescribers, and pharmacies, staying current with prescribing guidelines and regulatory changes.
SmithRx is a rapidly growing, venture-backed Health-Tech company that disrupts the expensive Pharmacy Benefit Management (PBM) sector with a next-generation drug acquisition platform. Since 2016, they have onboarded hundreds of thousands of members and pride themselves on a mission-driven, collaborative culture guided by values of Integrity, Courage, and Together.
Manage end-to-end drug prior authorization and claims cases, assessing requests against clinical guidelines and plan provisions.
Communicate authorization outcomes clearly to members, providers, and internal stakeholders while resolving escalated and complex scenarios.
Serve as a subject matter expert to support teams, training, and continuous improvement initiatives.
The hiring company operates in the insurance and benefits sector, managing complex drug prior authorization and claims cases. It is a global organization with a collaborative culture that values flexibility, continuous improvement, and employee well-being.
Coordinates utilization review and prior authorization requests, ensuring accurate entry into the UM platform.
Provides customer service to providers and members, confirming benefits and answering authorization questions.
Facilitates communication between reviewers, hospitals, and physicians to ensure timely decisions.
University of Utah Health Plans is a patient-focused organization that enhances health through patient care, research, and education. It is part of a nationally ranked academic medical center with five hospitals and eleven clinics, fostering a culture of collaboration and excellence.
Manage prescription workflows and provide clinical and operational support to the pharmacy enablement team.
Collaborate with RNs, providers, and coaches to coordinate care and resolve member issues.
Process clinical tickets, route faxes and records, and follow SOPs to maintain compliance.
Virta Health works to reverse metabolic disease in one billion people using technology, personalized nutrition, and virtual care delivery. It is a remote-first company backed by over $350 million from top-tier investors, partnering with health plans, employers, and government organizations.
Communicate with patients regarding appointments, treatment plans, and follow-ups.
Coordinate patient care between providers, specialists, and insurance companies.
Maintain accurate and confidential patient records in EHR/EMR systems.
SnappyCX provides remote clinical care coordination and administrative support to U.S.-based healthcare practices. The company values independence and professionalism, with a small, distributed team focused on HIPAA compliance and patient-centered care.
Leads enterprise authorization operations with direct impact on revenue protection, patient access, and reimbursement performance.
Manages a team responsible for insurance verification, pre-authorization, and timely processing of assigned services.
Collaborates with billing, registration, revenue cycle, clinical, and administrative teams to reduce preventable payment denials.
The partner company is a healthcare organization focused on revenue protection, patient access, and reimbursement performance. They provide a collaborative and mission-driven environment for teams working across complex healthcare operations.
Process referrals and prior authorizations, ensuring accurate and timely documentation.
Collaborate with clinical teams, physician offices, and insurance companies to resolve authorization issues.
Monitor denial reports, manage referral tracking, and communicate decisions to providers, staff, and patients.
Baystate Health is an integrated healthcare system serving western Massachusetts. With 12,000 employees and a community-focused culture, it includes five hospitals and offers career growth.
Review and process prior authorization requests for various medications.
Communicate prior authorization criteria to providers and act as a help desk.
Process requests via phone, fax, and web submission while maintaining HIPAA compliance.
Lumicera Health Services is a specialty pharmacy focused on optimizing patient well-being through transparency and stewardship. It fosters a diverse and creative work environment as part of the Navitus organization.
Apply pharmacy technician knowledge to support prescription intake, triage, and fulfillment across the patient access journey.
Coordinate with patients, prescribers, pharmacies, and internal teams to resolve prescription-processing and fulfillment barriers.
Manage cases with high accuracy and responsiveness to ensure timely patient access to therapy.
PRO-spectus is a healthcare services company providing patient support programs and pharmacy services. The company fosters a supportive, teamwork-driven culture focused on improving patients' lives, with employees who are dedicated and collaborative.
Provides administrative support to clinical teams including building medical management records and managing authorizations.
Conducts fax and telephonic outreach to members and providers for status updates and engagement.
Supports compliance monitoring and documentation in the medical management system.
Capital Blue Cross is a health insurance provider dedicated to improving the health and well-being of its members and communities. They are recognized as one of the "Best Places to Work in PA" with a culture focused on support, flexibility, and community involvement.
Manage prior authorization requests, reviewing clinical documentation and verifying ICD-10 and CPT codes.
Submit requests via payer portals, monitor pending cases, and follow up with insurers.
Investigate denials, prepare appeals, and coordinate with providers to prevent care delays.
Jobgether is an AI-powered job platform that matches candidates with relevant opportunities through objective review processes. It focuses on efficient recruitment and data privacy, using technology to support hiring decisions.
Review and respond to phone and fax inquiries from members, providers, and pharmacies for prior authorization.
Use multiple applications and follow procedures to accurately document and resolve inquiries.
Provide excellent customer service and meet or exceed call center metrics.
The Cigna Group is dedicated to improving the health and vitality of those we serve through Cigna Healthcare and Evernorth Health Services. We are a major healthcare organization focused on enhancing the lives of our clients, customers, and patients.
Prepare, review, and submit accurate prior authorization requests to PBMs and health plans for anti-obesity medications.
Act as an escalation point to resolve complex coverage inquiries from Medical Providers, Member Services, and Client Success.
Maintain HIPAA compliance and accurately document hours using designated ADP pay codes.
Vida is a virtual, personalized obesity care provider that uses evidence-based treatment to help patients manage obesity and related conditions. It is trusted by Fortune 100 companies and fosters a diverse, inclusive culture.
Process medication prior authorizations and support ambulatory care pharmacy services to improve patient access to medications.
Research and identify potential medication access options, including prior authorization, drug assistance programs, copay discount cards, and foundation grants.
Serve as a liaison between patients, providers, pharmacies, and assistance programs, managing renewals and eligibility.
Dignity Health Medical Foundation is a California nonprofit public benefit corporation that provides comprehensive health care services through its care centers. It is an affiliate of Dignity Health, one of the largest health systems in the nation, with a culture centered on purposeful work, growth, and excellence in care.
Prepare and review credentialing and recredentialing applications, provider updates, termination letters, and TIN change documents.
Conduct biweekly follow-up with payers, track application progress, and maintain detailed records in internal systems and dashboards.
Support team projects such as new provider onboarding, payer roster updates, and quality reviews while protecting confidential information.
Specialty Dental Brands is a dental support organization that partners with pediatric dentistry, orthodontics, and oral surgery practices across the country, empowering teams with technology, resources, and support. The company values a people-first culture, collaboration, continuous learning, and creating positive experiences for providers, practices, and employees.
Review prior authorization requests, appeals, and overrides using clinical guidelines and benefit criteria.
Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
Provide clear, empathetic support to members, prescribers, and pharmacies via phone, while staying current with clinical guidelines.
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. It is the intelligence platform powering benefits plans for millions of Americans, focused on operational efficiency and service excellence.
Maintain clinical drug lists and prior authorization documents, resolve drug list and benefit setup questions, and prepare reports and client business review materials.
Investigate claim rejections related to drug list platform configuration and coordinate with pharmacists and operational teams to meet deadlines.
Identify opportunities to improve accuracy and efficiency through technology, automation, and AI-enabled tools.
Prescryptive is a healthcare technology company enabling the direct access marketplace for prescription drugs. As an Equal Opportunity Employer, the company values bold aspirations and a passion for improving consumer health and wellbeing.
Help members navigate US health insurance, including billing questions, denied claims, and appeals.
Coordinate with providers, insurers, and members to resolve coverage issues and prior authorizations.
Translate complex insurance benefits into clear guidance and identify trends to improve the member experience.
This company provides a global safety net for remote workers, offering health, income, and travel coverage. It operates as a remote-first organization with a culture of empathy, integrity, and a mission to improve access to healthcare worldwide.