Source Job

• Conduct MTM and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS).
• Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services.
• Provide Medicare Part D clinical, operational and educational support by maintaining knowledge of all existing updates and regulations regarding the MTM program.

Navitus is an organization that was founded as an alternative to traditional pharmacy benefit manager (PBM) models. They are committed to removing cost from the drug supply chain to make medications more affordable for people; Navitus welcomes new ideas and shares a passion for excellent service to customers and each other.

• Communicate with patients telephonically regarding the Shields Partner Pharmacy program.
• Access patient EMR to review chart notes prior to outbound calls.
• Identify medications requiring special storage and necessary supplies.

Shields Health Solutions collaborates with hospital leaders to elevate specialty pharmacy care. They focus on enhancing outcomes, improving access, and lowering costs through integrated pharmacy programs; additionally, they are committed to equal opportunity and diversity within their workforce.

• Strengthening the connection between the patient and their primary care physician/medical practice staff, as well as improving the patient’s health and well-being.
• Engaging patients and helping them navigate their care, solve their healthcare issues, and improves communication with their medical practice.
• Assisting the patient in achieving better health outcomes by addressing their questions and concerns, connecting them with the medical practice.

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Their goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.

• Enter into Written Collaborative Practice Agreements and/or a Collaborate Relationship with the CCS Practitioners, depending on state specific requirements.
• Provide supervision and collaborative oversight for CCS Practitioners who provide CCS Practitioner Services in the Service Area, consistent with the Collaborative Practice Agreements.
• Be available to the CCS Practitioner for consultation, as needed, either on site or by electronic access, including but not limited to, telephone, facsimile and email, during normal business hours.

ComplexCare Solutions delivers home assessment services for health plans nationwide. They are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

• Answer incoming calls and assist customers, pharmacies, and doctor offices.
• Research information in databases to resolve customer service issues
• Maintain composure in escalated situations

Qualfon delivers engaging interactions and positive experiences. With a mission to help as many people as possible pursue their total vocation, they strive to be the partner of choice for their clients, creating ever-growing job opportunities.

• Respond to inbound inquiries from providers, medical office staff, and payers by phone, email, and internal messaging
• Support providers with real-time order status updates, prescription processing steps, and plan-specific requirements
• Triage escalations and resolve urgent or complex order-level issues efficiently

PHIL is a Series D health-tech startup building a platform that interfaces between doctors, pharmacies, and patients to streamline the process of patients receiving prescriptions. The team at PHIL is a group of like-minded individuals from varying backgrounds, passionate about creating a new and innovative healthcare platform that is focused on patient experience and overall human wellbeing.

• Serve as the Medicare coverage determinations and redeterminations subject matter expert.
• Create and uphold robust policies and procedures for coverage determinations and redeterminations in accordance with CMS guidelines.
• Recruit, onboard, train, and manage Medicare PA and Appeals pharmacists and technicians.

Judi Health provides a comprehensive suite of solutions for employers and health plans. Together with our clients, they’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.