Source Job

• Review and audit prescriptions and delivery slips for completion and accuracy.
• Collaborate with clinicians in specialty clinics to ensure seamless medication management and adherence.
• Educate patients on how pharmacy services enhance care and improve outcomes.

Shields Health Solutions is a fast-growing leader in specialty pharmacy management services, dedicated to making a real difference in patients’ lives.

• Evaluate and review all appeals requests to render coverage determinations based on clinical criteria and medical necessity.
• Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to providers.
• Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times.

Judi Health offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi® the industry’s leading proprietary Enterprise Health Platform (EHP). 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.

• Lead and oversee Prior Authorization Operations across all lines of business.
• Manage Prior Authorization processes ensuring optimal efficiency and compliance.
• Drive cross-functional collaboration to align with organizational goals.

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They are rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.

• Review clinical documentation to determine medical necessity and program compliance.
• Decide on authorization or denial of prior approval requests via telephone.
• Provide pharmaceutical expertise to advisory board’s clinical workgroups.

UMass Chan Medical School welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.

• Provide integrated support to patients and physicians, taking a hands-on approach to improve patient care quality.
• Develop personalized relationships with patients and prescribers to enhance medication adherence and promote evidence-based care.
• Monitor patient adherence across sites and disease categories, focusing on oncology and other specialty-specific conditions.

Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment.

Oversee a team of pharmacy technicians in the prior authorization process. Analyze data and provide recommendations to maximize team agility and performance. Generate and deliver reports on technician metrics to stakeholders.

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans.

• Perform auditing of claims, ensuring processing, payment, and financial accuracy.
• Complete reporting of audits finalized with decision methodology for procedural and monetary errors.
• Communicate corrections and adjustments to Examiners as identified on pre-payment audits.

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their bills.

Document and communicate audit findings to management and recommend corrective actions to improve compliance. Provide staff education on privacy standards, compliance policies, and regulatory requirements. Review, investigate, and respond to facility inspections and/or deficiencies issued by regulatory agencies.

SimonMed Imaging is the fastest growing outpatient radiology practice in the Nation and is committed to excellence and improving patient care.

• Provides integrated off-site support to patients, pharmacists, and providers for total quality patient care.
• Delivers medication adherence support utilizing various tools and applications.
• Educates prospective pharmacy patients on how the hospital pharmacy improves their overall care.

Shields Health Solutions partners with hospitals to build and manage specialty pharmacies within their systems. They aim to improve medication access, adherence, and outcomes for patients with chronic conditions.

Provide medication management for individuals, including medication reconciliation, dose optimization, and medication adherence counseling. Collaborate with the interdisciplinary care team to develop individualized care plans that align with evidence-based guidelines. Monitor and evaluate medication regimens to ensure clinical criteria are met, including therapeutic goals, adverse effects, and drug interactions.

Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type.