Communicate with insurance companies to facilitate medication approvals.
Navigate pharmacy systems to input data and prepare action plans.
Communicate with patients and clinician offices regarding medication access.
Shields Health Solutions focuses on improving patient care by removing barriers to medication access. They value creating a positive and inclusive work environment where employees can grow their careers.
Act as the primary point of contact for incoming member calls and prior authorization inquiries.
Accurately advise callers on options for exception requests based on client benefit elections.
Efficiently triage incoming calls with professional phone etiquette from members, prescribers, and pharmacies.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They manage health benefits for employers, TPAs, and health plans and are rebuilding trust in healthcare in the U.S.
Lead and nurture a dynamic team of clinical pharmacists and technicians.
Create and uphold robust policies and procedures for utilization management review.
Generate and deliver comprehensive reports on prior authorization metrics.
Judi Health is an enterprise health technology company providing solutions for employers and health plans, including pharmacy benefit management and health benefit management. Judi Health values diversity and provides equal employment opportunities to all employees and applicants.
Conducting outbound telephonic outreach to patients to support medication adherence, address barriers to care, and promote engagement with their healthcare plan.
Assisting patients in navigating healthcare services, including coordination of prior authorizations, benefit inquiries, and referrals to appropriate care resources.
Supporting care gap closure activities by identifying members in need of medication reviews, refills, or preventive services and coordinating appropriate follow-up.
Guidehealth is a data-powered healthcare company focused on operational excellence with the goal to make healthcare affordable, improve patient health, and restore fulfillment of practicing medicine for providers. The company is growing and innovative adapting to evolving business needs, and supporting cross-functional initiatives.
Review patient care notes for clinical data needed for prior authorization approvals.
Monitor patient adherence across all sites and disease categories, focusing on oncology and specialty-specific disease states.
Recommend alternative therapeutic drug regimens and disease-specific treatments according to guidelines.
Shields Health Solutions provides integrated pharmacy solutions to health systems. They focus on improving patient care and outcomes through specialized pharmacy programs and services. The company values innovation, collaboration, and a patient-centered approach.
Answer inbound calls and return voicemails from members, delivering exemplary customer service and support.
Troubleshoot and resolve prescription-related issues for members whose plans utilize CVS or Carelon as the PBM.
Coordinate with providers’ offices and retail/mail-order pharmacies as needed to resolve claims processing, prior authorization, and medication access issues.
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. They focus on cost containment strategies and driving down the cost of plans with innovative solutions. Point C provides equal opportunity in all employment practices.
Provide subject matter expertise support on Judi’s function and reporting capabilities related to prior authorization
Take accountability for accurate translation of reporting requirements for Capital Rx’s customers
Support analytics and reporting needs for the prior authorization team and related groups
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, with the industry’s leading proprietary Enterprise Health Platform.
Review incoming referral orders to assess patient’s needs based on diagnosis, insurance coverage or lack thereof, and previous treatments.
Verify patient information including demographics, insurance coverage and financial status; confirm patient eligibility for health care coverage and clarify any managed care arrangements.
Contact the patient prior to service to inform them of their estimate and collect any pre-payments at that time.
OHSU is Oregon's only public academic health center, caring for patients and leading groundbreaking research. As Portland's largest employer, they offer opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.