Function in the Medication Support Navigator - Care Coordinator role supporting both regions and the Medication Navigator team.
Ensure timely completion of referrals and supports Medication Support Navigator team in timely completion.
Direct people leadership of the Medication Support Navigator team including 1:1s and performance management.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans.
Directly lead and manage a team of Patient Support Associates to ensure medication adherence or timely prior authorization.
Proactively manage support in assigned hospitals and/or clinics to ensure patients receive medications on-time.
Provide front-line supervision and ongoing coaching and performance management to Patient Support team.
Shields Health Solutions is a specialty pharmacy management service provider. They are a fast-growing company that values motivated self-starters with a positive outlook and a focus on high-quality work.
Supervise day-to-day operations of assigned Utilization Management staff.
Provide full people management for assigned Utilization Management teams, including hiring and performance management.
Drive team performance against key metrics, including engagement, productivity, and quality scores.
Personify Health has created a personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together. Their data-driven solutions aim to reduce costs while improving health outcomes, empowering people to lead healthier lives.
Verify patient insurance coverage, eligibility, and benefits prior to services.
Obtain required prior authorizations from payers for services, procedures, or medications.
Monitor and track pending authorizations; follow up to prevent delays.
Prompt is revolutionizing healthcare with modern software for rehab therapy businesses. As the fastest-growing company in the therapy EMR space, Prompt is setting a new standard in healthcare technology with a team of exceptionally talented individuals.
Take incoming requests for appeals ensuring customer service and maximizing productivity.
Work with appeals team for multiple lines of business ensuring appeal submission for review.
Maintain quality standards, remain current on updated processes, and follow SOPs and HIPAA guidelines.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They have full-service health benefit management solutions to employers, TPAs, and health plans.
Responsible to secure outpatient accounts by performing insurance verification and obtaining benefit information.
Calculates patient estimates and obtains prior authorization before services are rendered.
Works with physicians, nurses, clinic managers, and financial advocates to resolve issues that arise during the prior authorizations process.
University of Utah Health is a patient-focused organization that enhances the health and well-being of people through patient care, research, and education. They have five hospitals and eleven clinics which provide excellence in comprehensive services, medical advancement, and overall patient outcomes.
Own product requirements for Medicare FFS enrollment workflows within HealthRules Payer, including enrollment transaction processing and plan benefit package configuration.
Drive accumulator configuration requirements for deductible, out-of-pocket maximum and benefit limit tracking across claim types and benefit periods.
Evaluate CMS rulemaking cycles and annual benefit design updates to assess downstream impact on HealthRules Payer configuration and adjudication behavior.
HealthEdge provides an integrated platform of solutions that enables health plans to converge their data and harness insights to improve outcomes. We are a team of visionary, empathetic people who believe technology should remove friction from healthcare and operate with a collaborative culture focused on making a real difference for payers and their members.
Responsible for supporting the implementation, maintenance, analysis, and quality assurance of ConnectiveRx pharmaceutical affordability programs.
Accountable for program set-ups and maintenance, performs quality control on program setups and updates, and investigates adjudication outcomes and data discrepancies.
Applies business rules consistently to ensure operational accuracy and program integrity and works independently on routine tasks.
ConnectiveRx helps pharmaceutical manufacturers untangle the complex prescription process. They bring together diverse voices to allow patients to build trusting relationships with their medication brands. ConnectiveRx offers comprehensive benefits including medical, dental, vision, life, and disability insurance.
Supports outbound calls and data/benefit analysis related to various clinical pharmacy programs.
Performs advanced administrative/operational/member support duties.
Initiates and responds professionally to a high volume of calls in a timely and efficient manner.
Capital Blue Cross promises to go the extra mile for their team and community. It appears to be a large company, that values its employees, as they are consistently voted one of the “Best Places to Work in PA”.
Execute the full BV and PA lifecycle for Spravato, TMS, and other interventional treatments.
Conduct phone- and portal-based verification and end-to-end PA submission and follow-up.
Provide clear written communication to the practice, ensuring patients can be scheduled with confidence.
Osmind is a technology, services, and data company focused exclusively on psychiatry. They serve a network of 1,000+ independent psychiatry practices across the country, helping them provide high-quality care, scale as businesses, and contribute to research with their purpose-built EHR, software solutions, clinician community, and managed services.
Evaluates member health metrics and professional resources to inform UM/CM initiatives and programs.
Refers members and providers to G.E.H.A resources and programs, as indicated, maximizing their health plan benefits.
Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes.
Government Employees Health Association (G.E.H.A) is a nonprofit member association providing health and dental benefits to millions of federal employees and retirees since 1937. G.E.H.A is headquartered in Lee's Summit, Missouri, offering hybrid and work-from-home options for many roles.
Conduct high-volume calls with patients, providers, and pharmacies using established protocols.
Collaborate with patients to remove barriers to medication adherence and escalate clinical barriers to a pharmacist.
Accurately document all interactions, outcomes, and identified barriers in appropriate systems.
Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. Founded in 2014, they've become the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Serve as the primary contact for CM/UM programs and operational questions related to the MyCare Platform.
Build relationships with provider offices through outreach and timely follow-up, resolving issues within defined turnaround times.
Educate providers on submission requirements, documentation, timelines, and available CM/UM resources.
Personify Health created a personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while improving health outcomes.
Analyzes and answers inquiries regarding pharmacy claims adjudication.
Adjudicates pharmacy claims and processes pharmacy claims for payment.
Performs varied activities and moderately complex administrative/operational/customer support assignments.
Humana is committed to helping people live healthy lives, creating personalized experiences, and working collaboratively. They offer medical, dental, and vision benefits, a 401(k) retirement savings plan, and paid time off.