Process medication prior authorizations and support ambulatory care pharmacy services to improve patient access to medications.
Research and identify potential medication access options, including prior authorization, drug assistance programs, copay discount cards, and foundation grants.
Serve as a liaison between patients, providers, pharmacies, and assistance programs, managing renewals and eligibility.
Assist patients with enrolling in our Prescription Payment Plan and verifying eligibility.
Coordinate with pharmacies to apply benefits and reduce out-of-pocket costs.
Guide patients through renewals and updates to ensure continued access.
We are a team dedicated to improving access to affordable prescription medications for patients. We partner with insurance companies, healthcare providers, and pharmacies to reduce the financial burden of medications, ensuring patients can access treatments without excessive costs.
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.
Review and process prior authorization requests for various medications.
Communicate prior authorization criteria to providers and act as a help desk.
Process requests via phone, fax, and web submission while maintaining HIPAA compliance.
Lumicera Health Services is a specialty pharmacy focused on optimizing patient well-being through transparency and stewardship. It fosters a diverse and creative work environment as part of the Navitus organization.
Conduct high-volume outbound and inbound calls with patients, providers, and pharmacies to support medication adherence.
Collaborate with patients to identify and remove barriers to medication adherence, escalating clinical issues to pharmacists.
Document interactions and coordinate with providers and pharmacies to ensure prescription refills occur as scheduled.
Aledade PBC is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. Founded in 2014, it has become the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
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.
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.
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.
Manage, triage, and assign clinical pharmacy referrals to the appropriate clinical pharmacy team member.
Schedule patient/caregiver appointments and prepare charts for pharmacist-driven clinical programs.
Communicate with pharmacies, insurance companies, and internal teams to resolve medication access barriers.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs, delivering 24/7 virtual-first and in-home medical, behavioral, and social care. The company is guided by values like Children First, Earn Trust, and Embrace Humanity, fostering a culture of empathy, innovation, and diverse perspectives.
Serve as clinical subject matter expert and operational driver for prior authorization.
Build tools, drive process improvements, and mentor peer pharmacists on clinical protocols.
Handle complex escalations, appeals, and cross-functional collaboration to scale clinical operations.
SmithRx is a venture-backed Health-Tech company disrupting the PBM market with cutting-edge technology. Since 2016, we have onboarded hundreds of thousands of members and pride ourselves on a mission-driven, collaborative culture.
Identify members meeting outreach criteria using internal data and systems.
Conduct telephone and in-person outreach to coordinate appointments and address care barriers.
Connect members with community resources and support Medicaid eligibility and care integration.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. They focus on efficient, objective application review and data privacy compliance.
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.
Coordinates utilization review and prior authorization requests, ensuring accurate entry into the UM platform.
Provides customer service to providers and members, confirming benefits and answering authorization questions.
Facilitates communication between reviewers, hospitals, and physicians to ensure timely decisions.
University of Utah Health Plans is a patient-focused organization that enhances health through patient care, research, and education. It is part of a nationally ranked academic medical center with five hospitals and eleven clinics, fostering a culture of collaboration and excellence.
Process referrals and prior authorizations, ensuring accurate and timely documentation.
Collaborate with clinical teams, physician offices, and insurance companies to resolve authorization issues.
Monitor denial reports, manage referral tracking, and communicate decisions to providers, staff, and patients.
Baystate Health is an integrated healthcare system serving western Massachusetts. With 12,000 employees and a community-focused culture, it includes five hospitals and offers career growth.
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.
Coordinate clinical appointments, manage referrals, and proactively follow up with families to reduce gaps in care.
Provide evidence-based education to families on chronic condition management, medication regimens, and treatment plans.
Manage medication prior authorizations, coordinate with pharmacies, and document clinical interactions across EHR platforms.
Clarity Pediatrics is reimagining pediatric chronic care, starting with ADHD and expanding to obesity and overweight management. The company is a fast-growing startup with a leadership team committed to clinical excellence and a remote-friendly culture.
Answer and respond to incoming calls from nursing staff and doctors to address concerns and inquiries.
Process new and refill prescriptions, verify eligibility, and input prescriptions while maintaining productivity and quality standards.
Document correspondence, prepare audit sheets, and forward incomplete scripts to the appropriate department for resolution.
Symbria Rx Services provides pharmacy, rehabilitation, and well-being services for senior-living and post-acute communities. The company is a 100% employee-owned healthcare provider with over 20 years of experience and a culture guided by integrity, compassion, stewardship, innovation, and teamwork.
Coordinate the end-to-end provider enrollment process, preparing and submitting applications to Medicare, Medicaid, and other payers.
Maintain accuracy of provider data in systems like NPPES, PECOS, and CAQH, and track facility privileging requirements.
Collaborate with internal teams to align enrollment timelines and ensure compliance with federal, state, and facility regulations.
Curana Health is a national leader in value-based care for older adults, providing primary care services and care coordination in senior living communities and skilled nursing facilities. Founded in 2021, the company serves over 200,000 seniors across 1,500+ communities and employs more than 1,000 clinicians, with a fast-paced, mission-driven culture.
Manage prescription workflows and provide clinical and operational support to the pharmacy enablement team.
Collaborate with RNs, providers, and coaches to coordinate care and resolve member issues.
Process clinical tickets, route faxes and records, and follow SOPs to maintain compliance.
Virta Health works to reverse metabolic disease in one billion people using technology, personalized nutrition, and virtual care delivery. It is a remote-first company backed by over $350 million from top-tier investors, partnering with health plans, employers, and government organizations.
Apply pharmacy technician knowledge to support prescription intake, triage, and fulfillment across the patient access journey.
Coordinate with patients, prescribers, pharmacies, and internal teams to resolve prescription-processing and fulfillment barriers.
Manage cases with high accuracy and responsiveness to ensure timely patient access to therapy.
PRO-spectus is a healthcare services company providing patient support programs and pharmacy services. The company fosters a supportive, teamwork-driven culture focused on improving patients' lives, with employees who are dedicated and collaborative.