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.
Provide clinical expertise and strategic recommendations to clients and internal teams on drug spend, formulary compliance, and clinical programs.
Act as a clinical liaison between Plan Operations and other departments, communicating formulary changes and program updates.
Analyze drug benefit designs, prepare clinical marketing materials, and support go-live activities for new client groups.
SmithRx is a venture-backed health-tech company disrupting the PBM sector with a next-generation drug acquisition platform. It has hundreds of thousands of members and a mission-driven, collaborative culture guided by integrity, courage, and togetherness.
Perform patient-specific medication reviews and develop recommendations for medical drug utilization management and Medication Therapy Management.
Resolve medication and pharmacy issues for members triaged from Member Services or other departments.
Act as subject matter expert for audits, quality improvement, and LEAN projects.
IEHP is a not-for-profit health plan dedicated to healing and inspiring the human spirit by providing quality healthcare services to members. They emphasize a supportive culture with career growth and wellness programs for their team.
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.
Manage formularies, coverage determinations, and benefit design for PBM services.
Resolve clinical inquiries from members, clients, providers, and pharmacies.
Support P&T Committees with drug monographs, summaries, and medication policies.
OHSU is Oregon's only public academic health center with hospitals, clinics, and research schools. It is Portland's largest employer and a national research hub, welcoming diverse backgrounds.
Provide integrated support to patients and physicians to improve medication adherence and quality of care.
Review patient assessments and EMRs to develop care plans and optimize drug therapies.
Monitor adherence, oversee technicians, and ensure compliance with pharmacy regulations.
Shields Health Solutions provides integrated specialty pharmacy support to patients and physicians. The company emphasizes high-integrity, quality-focused teamwork and confidentiality in a remote work environment.
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.
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.
Serve as the designated Pharmacist in Charge and fulfill all related responsibilities.
Review and approve licensing submissions, renewals, and regulatory documentation.
Collaborate with the operations and compliance team to support ongoing compliance.
MD Exam is a healthcare organization specializing in sterile compounding operations. They are a growing company with an experienced team dedicated to compliance and patient safety.
Develop, test, train, maintain, and support clinical systems used in medication management and pharmacy automation.
Serve as a non-supervisory technical and operational leader within Pharmacy Informatics, coordinating complex cross-functional initiatives.
Ensure technology solutions align with clinical, operational, and strategic needs across the pharmacy enterprise.
The Ohio State University is a top-20 public university and one of America's leading academic health centers. It offers a strong sense of community and resources that support professional growth across many fields.
Serve as the designated Pharmacist-in-Charge, reviewing licensing submissions and regulatory documentation.
Work with pharmacy operations and compliance team to support ongoing compliance and Board-related discussions.
Provide professional guidance and identify issues requiring follow-up or corrective action.
MD Exam is a growing healthcare organization with established sterile compounding operations. It offers an experienced team support and a collaborative culture focused on patient safety and compliance.
Approves and oversees medication ordering, compounding, and dispensing for patients.
Supervises pharmacy technicians and ensures compliance with state and federal regulations.
Participates in clinical initiatives, monitors patient progress, and educates healthcare staff.
The University of Rochester is a leading research university and academic medical center committed to learning, discovery, and healing. The institution values equity, integrity, and respect, fostering an inclusive culture for all employees.