Collaborates with clinic teams to ensure required clinical information is complete for prior authorization requests and approvals.
Reviews off-label regimens for clinical support, verifies provider documentation, and communicates directly with patients to address insurance barriers.
Serves as a resource for prior authorization teams, supports provider education, and leads process improvement initiatives and committee participation.
Provide comprehensive medication management, including reconciliation, dose optimization, adherence support, and drug‑level assessments aligned with evidence‑based standards.
Partner with physicians, specialists, and interdisciplinary teams to order individualized care plans under a CPA and promote seamless medication coordination.
Monitor therapy effectiveness and safety, identify optimization and intervene as appropriate.
Shields Health Solutions is redefining patient care through health-system integrated specialty pharmacy. They are known for elevating patient care at nationally recognized Academic Medical Centers and building meaningful relationships with patients and providers.
Documents and maintains patient assessments and care plans in electronic systems.
Oversees clinical programs to manage quality and execution at health center pharmacies.
Provides educational and consultant services in pharmacology and drug therapy.
VytlOne provides pharmacy services and managed pharmacy solutions. It is a mission-driven organization with a collaborative, innovative team culture focused on improving healthcare outcomes.
Prepare complex prior authorization requests by identifying clinical guidelines for review.
Proactively obtain clinical information from prescribers to ensure all aspects of clinical guidelines are addressed.
Effectively use problem solving skills to identify gaps and resolve concerns.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They offer full-service health benefit management solutions, and consolidate all claim administration-related workflows in one secure platform.
Review medication orders for accuracy and safety, providing patient counseling.
Collaborate with healthcare providers, monitor drug interactions, and maintain records.
Ensure regulatory compliance, contribute to protocol development, and assist in training.
Shields Health Solutions provides pharmaceutical care services to patients, collaborating with healthcare professionals . They focus on safe and effective medication therapies.
Develop and maintain a quality audit program for the Clinical Review Team.
Ensure high-quality reviews and adherence to regulatory requirements.
Deliver exceptional member, provider, and employee experiences.
SmithRx is a rapidly growing Health-Tech company that aims to disrupt the Pharmacy Benefit Management (PBM) sector using technology and customer service. The company has a mission-driven and collaborative culture, with hundreds of thousands of members onboarded since 2016.
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.
Develops workflows, protocols, and policies that support efficient and compliant TOC operations.
Provides leadership and supervision to designated groups of employees including assurance of quality service delivered by a competent staff to consistently meet the needs of the hospital patients.
Develop, implement, and continuously improve TOC pharmacy programs aligned with organizational goals and regulatory requirements.
Baptist Health is a full-spectrum health system dedicated to improving the health of the communities it serves. The Baptist Health family consists of 10 hospitals, employed and independent physicians, and more than 470 points of care and employs more than 24,000 people in Kentucky and surrounding states.
Counsel patients via telephonic outreach on medication adherence and address medication-related problems.
Collaborate with physicians and clinical staff to optimize medication management workflow and patient experience.
Develop and maintain standardized resources, educational tools, and clinical protocols to improve medication outcomes.
Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country and have a collaborative, inclusive, and remote-first culture.
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.
Responsible for remote services, including medication interpretation and dispensing.
Collaborates with care providers to ensure safe and cost-effective medication use.
Oversees pharmacy technicians and support staff.
Brown University Health is Rhode Island's largest health system and private employer, offering premier health services and the only Level I Trauma Center for southeastern New England. The not-for-profit system comprises three teaching hospitals of The Warren Alpert Medical School of Brown University and community hospitals offering a broad range of health services.
Provides direct patient care in hospital or community-based clinics.
Optimizes drug therapy and outcomes using evidence-based standards of care.
Provides effective, efficient and accurate ambulatory pharmaceutical care.
Saint Joseph East is a 217-bed, full-service, community hospital located in Lexington, Kentucky. CHI Saint Joseph Health is part of CommonSpirit Health, a non-profit, Catholic health system dedicated to advancing health for all people with approximately 175,000 team members and 25,000 physicians and advanced practice clinicians.
Manage the standard credentialing review process for pharmacies.
Review exclusion lists to identify any excluded pharmacies.
Manage the development and maintenance of a credentialing database.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They have solutions such as Capital Rx and Judi® which consolidates all claim administration-related workflows in one scalable, secure platform.
Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
Conduct member outreach, education, and follow-up to support adherence and understanding
Point C is a national third-party administrator (TPA) delivering customized self-funded benefit programs with local market presence. They focus on cost containment strategies with innovative solutions. They are driven by a clear and impactful mission.
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.
Independently manage tasks and projects to meet deadlines.
Provide excellent written and verbal communication to internal teams as the clinical subject matter expert.
Support the clinical strategy team to enhance drug pathways and clinical programs.
SmithRx is a rapidly growing, venture-backed Health-Tech company that aims to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector. They have a mission-driven and collaborative culture that inspires their employees to do their best work.
Guide healthcare providers through the reimbursement process, including prior authorizations and appeals.
Work with insurance companies and third-party administrators to address coverage issues.
Provide education regarding insurance benefits and financial assistance programs.
Amplity is a full-service go-to partner of biopharma companies that delivers flexible + specialized medical + commercial services. Amplity transforms how breakthrough treatments reach the people who need them with expert-led teams delivering contract medical, commercial + communications excellence for 40+ years.
Review and process patients’ enrollment forms to the Patient Assistance Program (PAP).
Caretria is dedicated to improving patient access to medications. Become one of their contributors and join the Caretria Team! They offer a comprehensive benefits package.
Manages the development, modification, implementation, and coordination of systems and processes necessary for pharmacies to meet relevant accreditation requirements.
Manages the design, development, and implementation of improvement projects and initiatives supporting quality and accreditation.
Monitor changes to accreditation standards and assist with updates to applicable policies and procedures to ensure compliance with standards.
VytlOne, formerly Maxor, provides customers and patients with exceptional pharmacy services. They have a reputation as a premier employer by offering rewarding career opportunities and believe their employees are their most important assets and strive to make a difference in peoples’ lives.