Serve as primary point of contact for specialty pharmacy patients from enrollment through therapy adherence, handling benefits verification and prior authorization.
Manage a caseload independently, perform outbound calls, and coordinate with pharmacy partners to ensure accurate therapy and shipment status.
Maintain strict patient confidentiality per HIPAA, recognize and report adverse events, and follow program-specific protocols.
Caretria provides patient support services for specialty pharmacy patients, focusing on enrollment, benefits verification, and care coordination. The company values empathy, urgency, and accuracy, and offers a comprehensive benefits package to its employees.
Oversee prior authorization technicians and administrative PA functions.
Analyze data and provide staffing, workflow, and system enhancement recommendations.
Investigate/resolve escalated issues from clients and providers.
Judi Health is an enterprise health technology company providing a suite of solutions for employers and health plans. They have a comprehensive Enterprise Health Platform that consolidates all claim administration-related workflows in one scalable, secure platform.
Provide medication management services inclusive of medication access, education, adherence, and comprehensive medication management for pediatric patients.
Act as liaison between the designated region and the medication management center of excellence, ensuring compliance with all regulatory authorities.
Document encounters in the electronic medical record and promote evidence-based, cost-effective medication 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, with a focus on compassion and an unwavering commitment to children with medical complexity.
Review appeals for commercial and Part D plans, rendering determinations based on clinical guidelines and regulatory requirements.
Serve as a clinical reviewer and subject matter support, performing independent research and retrospective case reviews.
Assist with CMS client audits, investigate appeal determination questions, and support clinical training activities.
MedImpact delivers leading edge pharmaceutical and technology related solutions that improve the value of healthcare, providing transparency and choice. Privately-held for over three decades, it is one of the leading pharmacy benefit managers in America, committed to making prescription benefits understandable and accessible.
Process referrals to MTM team and schedule appointments for patients.
Provide phone support and document patient information in electronic health records.
Assist with prior authorizations and billing to help patients access affordable medications.
UnityPoint Health is a healthcare system providing medical services. It is recognized as a Top 150 Place to Work in Healthcare and offers a supportive culture for team members.
Assists RedBox Rx patients via phone, chat and email.
Perform drug utilization review and pre-verification of prescriptions.
Provides counseling to RedBox Rx patients in accordance with all state and federal statutes and regulations.
Hy-Vee's people are its strength, promising "a helpful smile in every aisle." They aim for a fully engaged and committed workforce supporting customers and each other.
Provide patient care and advanced clinical pharmacy services in the ambulatory pharmacy space.
Collaborate with prescribers and manage medication therapy for direct patient care.
Document patient interactions across various electronic medical record platforms.
Saint Francis Hospital is a healthcare facility in Chicago, IL, part of Prime Healthcare SFIL Resurrection Medical Center. It offers a comprehensive benefits package and empowers staff with resources for growth and well-being.
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.
Work collaboratively with physicians, nurses, other healthcare providers, and patients to optimize drug therapy and outcomes using evidence-based standards of care.
Responsible for providing effective, efficient and accurate ambulatory pharmaceutical care to achieve organizational, patient care, and quality measure goals and objectives.
Prescribe pharmaceutical agents as outlined in the approved collaborative drug therapy management agreement including initiating, adjusting, and discontinuing drug therapy.
Dignity Health Medical Foundation, established in 1993, provides comprehensive health care services throughout California. They are an affiliate of Dignity Health, one of the largest health systems in the nation, striving to create purposeful work settings where staff can provide great care.
Conduct research and quality assurance for drug and biological policies.
Write business logic and translate industry references into Cotiviti policy.
Mentor new team members and assist with customer inquiries regarding clinical rules.
Cotiviti is a healthcare analytics company that provides clinical coding and policy solutions for health plans. They focus on maintaining accurate medical policy libraries and employ a global team, offering benefits like PTO and paid family leave.
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.
Accurately and timely review medication orders in a virtual environment.
Ensure safe medication use, regulatory compliance, and quality patient care.
Collaborate with healthcare teams through secure digital platforms to resolve medication-related issues.
Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. The organization prioritizes safety and provides an integrated system of healthcare experts committed to exceptional care.
Provide comprehensive medication management and drug‑level assessments.
Partner with physicians and interdisciplinary teams to order individualized care plans.
Monitor therapy effectiveness and safety, and provide recommendations to operations.
Shields Health Solutions is redefining patient care through health-system integrated specialty pharmacy. They are dedicated to elevating patient care at a nationally recognized Academic Medical Center and building meaningful relationships with patients and providers.
Leads specialty pharmacy services and medication access for ambulatory clinics across the region.
Supervises daily operations, workflow optimization, and staff development for Specialty Pharmacy Care Coordinators.
Collaborates with management on strategic initiatives, accreditation, and regulatory compliance.
Baptist Health is a full-spectrum health system dedicated to improving community health. Founded in 1924, it employs over 24,000 people and includes 10 hospitals and more than 470 points of care.
Support daily pharmacy operational workflows and administrative tasks to ensure timely and accurate prescription processing.
Provide frontline operational support to clinicians and internal teams for routine pharmacy workflow questions and requests.
Collaborate with the CX team to assist with basic prescription-related member issues and inquiries.
Lifeforce is the world's largest longevity medicine program. They bring together diagnostics, clinical experts, health coaches, and customized protocols to help people understand and optimize their bodies, functioning now and decades to come. They seem to have a modern and proactive company culture.
Perform remote order entry and CPOE evaluation and verification for acute-care hospitals.
Utilize clinical skills including monitoring, dosing, and reviewing patient medication therapy.
Collaborate with physicians and nurses to ensure continuity of care and regulatory compliance.
Cardinal Health distributes pharmaceuticals and provides medical products and data solutions for healthcare facilities. With over 45 years of experience, it is one of the largest employers of acute-care pharmacists in the United States, fostering an inclusive workplace that values diversity.
Serve as designated California PIC during licensing and pre-operational phase.
Review and approve licensing-related submissions as needed.
Participate in occasional compliance or Board-related discussions.
Greenstone Pharmacy is an expanding multi-state sterile compounding pharmacy preparing for California licensure and future operations. They are focused on building modern pharmacy infrastructure centered around compliance, operational excellence, telehealth integration, and scalable patient care solutions.
Collect and document clinical information from providers, pharmacies, and members.
Assist pharmacists with utilization management and appeals processing.
Communicate with prescribers and pharmacies regarding authorization status and coverage requirements.
The OccuNet Company is an innovative company striving to reduce the cost of healthcare through negotiations-driven levers and an experience-centric approach. We have an ambitious vision and are growing quickly, with a tight-knit culture based on the outward mindset philosophy emphasizing empathy and mutual respect.
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.