Source Job

• 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.

• 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.

• 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.

• Maintain full ownership and accountability for initiating phone contact to potential study participants.
• Conduct phone-based pre-screening interviews for potential study participants to determine pre-qualification status and eligibility for onsite screening visits.
• Input and record patient information and call notes into CTMS database and other portals and systems in compliance with standardized patient enrollment processes and procedures.

M3 Wake Research is an integrated network of premier investigational sites meeting the clinical research needs of global biopharmaceutical organizations.

• Oversee daily operations related to patient medication refill administration and inbound pharmacy patient inquiries.
• Manage clinic level and/or hospital service level escalations; build and action plan for resolution.
• Work with leadership to develop documented staffing plans and staffing forecasts that align with the needs of the region and productivity targets.

Shields Health Solutions is a fast-growing company in the specialty pharmacy management services.

Answer high volume of incoming calls and place outbound calls, responding to patient inquiries related to healthcare services. Act as primary point of contact for patients via phone, email and chat systems. Convert calls to scheduled appointments for CHOICE clinics.

CHOICE is the largest provider of pediatric dental care in the Southwest United States, and we pride ourselves on delivering high quality care to children in our communities.

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.

• Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
• Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
• Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.

Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.

• Provide one-on-one counseling to patients and caregivers on medication use, adherence, side effects, and cost-effective options.
• Conduct comprehensive medication reviews and reconciliation, particularly for patients with chronic conditions, multiple medications, or recent hospitalizations.
• Partner with care managers, health center pharmacists, and primary care providers to support patients in meeting treatment goals, including diabetes, hypertension, COPD, and other chronic conditions.

Medical Home Network (MHN) partners with Federally Qualified Health Centers (FQHCs) nationwide to transform care. They help FQHCs succeed in value-based care through technology, care model innovation, and strong partnerships, expanding reach to enhance care for their patients.

• Be the primary point of contact for all providers.
• Provide professional, accurate and timely responses to all provider inquiries.
• Maintain a current knowledge of all contract requirements and objectives.

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.

• 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.

• Deliver exceptional customer service to external and internal customers.
• Answer incoming calls and handle inquiries related to scheduling and general information.
• Ensure administrative and financial preparation of patients prior to their visit.

Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants.

Supports the clinical team through collaboration with prescribers and beneficiaries. Provides medication therapy management (MTM) services via triage of inbound calls. Documents services/activities in appropriate databases/software to ensure compliance.

Centene is committed to helping people live healthier lives by providing access to high-quality healthcare, innovative programs and a wide range of health solutions.

The Call Center Representative will focus on inbound and/or outbound assignments within the Call Center, which includes but is not limited to call management, outbound scheduling, authorization processing and other administrative tasks. The WelbeHealth Advocate will provide outstanding customer service to all stakeholders, and will be accountable for proper documentation and maintaining current and accurate records of all the scheduled appointments. Effectively coordinate the scheduling of participants’ appointments, including trouble-shooting conflicts or urgent needs, communicating with all stakeholders, and meeting appointment turn-around times.

The WelbeHealth PACE program helps seniors stay in their homes and communities by providing medical care and community-based services.

• Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
• Audit internal provider data against database records to ensure 100% accuracy before submission.
• Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.

Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.

Conduct investigative assignments primarily by phone and online research. Plan investigative strategies by reviewing case documentation and client instructions. Write detailed, accurate, and unbiased reports that clearly document findings and conclusions.

CoventBridge Group is a global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, and Counter-Fraud Programs.

• Answer incoming inquiries from patients, answer questions, and schedule appointments
• Make outbound phone calls to patients, pharmacies, and insurance companies
• Create and triage tickets in ServiceNow

Talkiatry transforms psychiatry with accessible, human, and responsible care. They’re a national mental health practice co-founded by a patient and a triple-board-certified psychiatrist to solve the problems both groups face in accessing and providing the highest quality treatment.

• 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.

• Ensuring providers are credentialed in a timely manner by monitoring the submission process.
• Monitoring submission processes, updating protocols, and managing Virtual Assistants/BPO.
• Communicating with payors and conducting regular reviews to validate internal credentialing data.

Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care. They are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients and have empowered more than ten thousand therapists.

Answer patient calls to schedule or update appointments and provide MyChart support. Use phone and EMR (Epic) systems to maintain accurate patient information. Participate in training to build consistency and contribute to a positive team culture.

Hummingbird partners with healthcare systems to transform how patients access care, enabling their providers to focus on what matters most – caring for patients.