Interpret, evaluate, and summarize information and datasets of varying sizes.
Determine benefit limits and secure insurance approvals for specialty infusion, oral chemotherapy and high-cost medications.
Serve as a resource to patients and staff regarding insurance and drug coverage questions.
Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, it is the only NCI-designated cancer center in Washington, employing a diverse workforce that values collaboration, compassion, and innovation.
Lead and manage a team of Patient Support Associates to ensure medication adherence, prior authorization completion, and financial assistance support.
Partner with hospital and clinic stakeholders through regular meetings and collaboration calls to ensure patients receive medications on time.
Monitor service level metrics, conduct audits, and implement process improvements to optimize workflows and drive performance.
Shields Health Solutions is a fast-growing leader in specialty pharmacy, dedicated to a patient-first culture and mission-driven care. They offer a collaborative, supportive environment with strong career growth and leadership development opportunities.
Prepare prior authorization requests by validating prescriber and member information and ensuring appropriate clinical guidelines.
Make outbound calls to providers to obtain additional clinical information for pharmacist review.
Review and analyze pharmacy claims data for proactive outreach and intervention.
Judi Health is an enterprise health technology company offering pharmacy benefit management and health benefit solutions for employers and health plans. They are a startup focused on rebuilding trust in healthcare in the U.S.
Proactively enroll patients in the Shields specialty pharmacy program through outbound calls, explaining the benefits of the service.
Review patient medical records to understand conditions and identify medications that require special handling or supplies.
Work flexible shifts within Eastern Time Zone hours, with occasional Saturday availability, and maintain confidentiality.
Shields Health Solutions provides specialty pharmacy services to health systems, helping patients access medications and support. They are a growing company focused on patient care, employee development, and a collaborative culture.
Design and configure prior authorization criteria, decision trees, and authorization parameters within the PA system.
Perform quality assurance and quality control reviews to ensure clinical intent and regulatory compliance.
Collaborate with internal teams and external clients to support delegated PA services and system optimization.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. The company is a public benefit corporation focused on rebuilding trust in healthcare in the U.S., with a culture that emphasizes collaboration and client support.
Assists with patient medication management and facilitates medication renewal requests.
Acts as a liaison between providers, patients, and pharmacies for prescriptions and prior authorizations.
Monitors prior authorization status and updates relevant parties throughout the process.
Mass General Brigham is a not-for-profit integrated health care system supporting patient care, research, teaching, and community service. They employ a diverse team of professionals including doctors, nurses, and tech experts, fostering a collaborative culture focused on exceptional care.
Lead and manage a team of Patient Support Associates to ensure medication adherence and prior authorization support.
Proactively manage support in assigned hospitals and clinics to ensure patients receive medications on time.
Provide front-line supervision, coaching, and performance management to the Patient Support team.
Shields Health Solutions is a fast-growing company specializing in specialty pharmacy management services. They are committed to high quality and patient-centered care, with a focus on employee development and team collaboration.
Review and process prior authorizations for biologics, oncology, and specialty therapies with timely and accurate completion.
Manage clinical documentation, submit and track authorization requests, and resolve issues with insurance providers.
Communicate effectively with patients, clinical staff, and insurance representatives to ensure compliance and workflow efficiency.
IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions like Rheumatoid Arthritis, Crohn's Disease, and Multiple Sclerosis. They are a rapidly growing company focused on patient comfort and employee empowerment, with core values of kindness, integrity, and continuous improvement.
Serve as a liaison between patients, providers, and internal teams to coordinate alternative pharmacy sourcing.
Identify and verify sourcing channels for non-covered or high-cost medications.
Track sourcing outcomes, maintain compliance, and support patient access to medications.
CommuniCare Family of Companies is a national leader in post-acute care, providing person-centered services for chronically ill or complex condition patients. With over 19,000 employees across 150+ facilities in six states, it is a family-owned company that values family, heart, and exceptional service.
Provide expertise in prior authorization and implement the Inspire Prior Authorization Program.
Support patient intake, verify insurance, and manage prior authorization requests.
Train sites on program requirements and assist with appeals through External Medical Review.
Inspire Medical Systems is a medical device company dedicated to treating Obstructive Sleep Apnea with an innovative FDA-approved device. The company values a people-first culture, offering excellent benefits, 401k matching, and flexible time off, and is committed to diversity and patient outcomes.
Handle inbound pharmacy calls and make outbound refill reminders to guide patients through the refill process.
Coordinate medication refills including data entry, claim adjudication, and resolving patient and provider inquiries.
Collaborate with pharmacists, clinicians, and internal teams to ensure timely and accurate patient support and process improvements.
Shields Health Solutions is a healthcare company that focuses on patient engagement and medication refill support for pharmacies. The company is large enough to offer benefits like medical, dental, and vision insurance, 401(k) match, and paid parental leave, and emphasizes a collaborative and supportive culture.
Serve as a key point of contact between patients, providers, pharmacies, and pharmacy benefit teams to coordinate alternative medication sourcing solutions.
Identify and validate appropriate sourcing options for non-covered, high-cost, specialty, or limited-distribution medications.
Assist with cost comparisons, savings analyses, reports, invoices, and documentation related to pharmacy sourcing activities.
The company helps patients navigate complex pharmacy solutions and alternative medication sourcing pathways. They are a mission-driven organization focused on patient-centered service.
Act as a patient and family advocate to obtain necessary information and fulfill payer authorization requirements.
Collaborate with providers and staff to ensure successful referral and authorization processes.
Track, follow up, and resolve authorization issues to minimize financial risks.
Lucile Packard Children's Hospital Stanford provides world-renowned pediatric care combining advanced technologies with family-centered care. It is a major children's hospital dedicated to caregiver education and state-of-the-art facilities.
Conduct benefit investigations, insurance verification, and prior authorizations to secure timely patient access to therapies.
Manage patient case files, coordinate product ordering and shipment with pharmacies and prescribers.
Handle inbound inquiries, report adverse events, and educate stakeholders on program requirements.
Jobgether is a platform that uses AI-powered matching to connect candidates with hiring companies. They focus on efficient, objective candidate screening and share top-fitting shortlists with employers.
Grow the number of new patients filling at Shields partner pharmacies.
Lead, coach, and inspire a team of outreach coordinators.
Develop new patient engagement strategies and optimize outreach workflows.
Shields Health Solutions partners with health systems to build specialty pharmacy programs. They are a growing organization focused on operational excellence and a winning culture.
Manage training projects and documentation for pharmacy systems, ensuring compliance and operational support.
Monitor helpdesk and equipment needs, and support strategic initiatives for employee software competence.
Maintain positive relationships with pharmacy, clinical, and hospital staff as an ambassador of VytlOne.
VytlOne provides pharmacy services and technology, enabling pharmacy care with a focus on patient impact. With over 1,500 employees and nearly 100 years of experience, they offer the stability of a Fortune 500 company with startup energy.
Verify patient insurance eligibility, benefits, and coverage prior to treatment.
Secure prior authorizations from insurance companies for scheduled medical services.
Maintain accurate records of authorizations, approvals, denials, and follow-up activities.
A-DTS is a healthcare services company focused on supporting patient access to care through insurance verification and authorization processes. The company is detail-oriented and emphasizes timely coordination in a remote work environment.
Review and interpret clinician assessments for prior authorization approvals and care plan recommendations.
Monitor patient adherence across all sites and disease categories, focusing on oncology and specialty states.
Provide medication therapy management including regimen review, drug therapy changes, and patient coaching.
Shields Health Solutions provides integrated support to improve patient care quality. The company employs a team of licensed pharmacists and support staff, focusing on medication adherence and evidence-based care.
Manage prior authorization workflows with vendors, providers, patients, and payors.
Develop processes and training materials for offshore teams to resolve authorization issues.
Own Prior Authorization outcomes and KPIs for your region or payors.
Alpaca Health enables clinicians to become entrepreneurs, starting in autism care. We've raised over $14M in funding and are growing 30% - 50% month over month, serving thousands of patients.