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.
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.
Support Pharmacists and patients by conducting medication reviews and optimizing prescription drug therapy.
Make outbound calls and take inbound calls to collect medication history and provide counseling.
Work remotely with a flexible schedule within EST business hours and participate in training with camera on.
Humana is a leading U.S. healthcare company that provides insurance and healthcare services to millions. With a large workforce, Humana fosters a caring community and supports career growth.
Provide exceptional phone-based customer service and process prescriptions with speed and accuracy.
Perform claim adjudication, billing, and eligibility checks while maintaining detailed patient records.
Act as a liaison between pharmacists and medical professionals, placing outbound calls to support patient care.
AnewHealth is a leading pharmacy care management company specializing in complex, chronic patient care. With over 1,400 team members and an award-winning culture, we serve more than 100,000 people across all 50 states.
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.
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.
Triage clinical program calls, schedule consultations, and conduct outreach to members, prescribers, and pharmacies.
Monitor outreach queues, document case activities, and escalate issues to ensure timely completion of clinical programs.
Maintain compliance with HIPAA and internal SOPs while providing compassionate, professional support to members and providers.
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. They consolidate pharmacy and medical benefits on a unified platform, leveraging AI-powered care delivery to enhance efficiency and service. The company is a growing startup focused on transforming healthcare infrastructure.
Processes electronic medication refill requests and communicates with providers and patients.
Ensures compliance with all HIPAA regulations and maintains patient confidentiality.
Provides excellent customer service and assists with prior authorization and medication assistance guidance.
St. Elizabeth Healthcare provides medical services as one of the largest healthcare providers in the Northern Kentucky region. The organization emphasizes a culture of caring for patients and each other, with a focus on innovation and community.
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.
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.
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.
Process new and refill prescriptions accurately while maintaining productivity and quality standards.
Contact physician offices and clients for refill authorization and order verification as needed.
Document correspondence, prepare audit sheets, and provide backup support to pharmacy groups.
Symbria Rx Services provides patient-centered pharmacy care to seniors in senior-living and post-acute settings. As a 100% employee-owned healthcare company, Symbria fosters a collaborative culture and has been serving for over 20 years.
Verify prescriptions and conduct drug utilization reviews to ensure regulatory compliance.
Review Prior Authorization requests and transfer prescriptions for timely medication delivery.
Collaborate across departments to improve patient health outcomes and adherence.
PHIL is a San Francisco-based health-tech startup building a platform that connects doctors, pharmacies, and patients to streamline prescription management and delivery. The team consists of mission-driven individuals from diverse backgrounds focused on creating an innovative healthcare platform.
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 cases to ensure clinical and operational standards are met.
Audit AI outputs, third-party reviews, and internal decisions for accuracy and compliance.
Collaborate cross-functionally to refine workflows and improve patient access to treatment.
Generator Health operates a platform that streamlines prior authorization processes for patients and providers. They handle tens of thousands of patients weekly and emphasize collaboration and accuracy in a high-autonomy remote environment.
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.
Review, process, and troubleshoot incoming Prior Authorization requests for various medications.
Accurately process requests according to regulatory and client-specific guidelines while meeting departmental performance metrics.
Work with clinical teams and handle requests via phone, fax, and web submission.
Navitus is a pharmacy benefit manager (PBM) alternative focused on reducing drug costs to make medications more affordable. The company offers a diverse and creative work environment with numerous employee benefits and growth opportunities.