Reviews, verifies, and interprets all physician orders received using the patient profile.
Screens medication orders for optimal usage, monitoring for allergies, interactions, and appropriate dosing.
Participates in continued education to meet regulatory requirements and organizational goals.
CommonSpirit Health is one of the nation's largest nonprofit Catholic healthcare organizations, delivering over 20 million patient encounters annually. With more than 157,000 employees, 45,000 nurses, and 25,000 physicians across 24 states, the organization focuses on creating a more just, equitable, and innovative healthcare delivery system.
Reviews Part D coverage determinations and appeals to ensure clinical appropriateness and compliance with CMS regulations.
Conducts Medication Therapy Management (MTM) activities, including comprehensive medication reviews and targeted interventions for high-risk members.
Supports pharmacy quality improvement initiatives aligned with Medicare Star Ratings and HEDIS measures.
Alignment Health is a healthcare company focused on serving seniors and the chronically ill through Medicare Advantage plans. The company is fast-growing with a team of passionate people dedicated to transforming senior care.
Provide expert-level medication therapy consultations to patients and providers, including Medication Therapy Management (MTM) services like Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs).
Collaborate with the Engineering team and leadership to improve Arine's software platform and guide the Clinical Support team, while managing a consistent volume of patient interactions.
Meet individual and team performance metrics related to outreach, engagement, documentation quality, and clinical outcomes, and adapt to evolving clinical projects and assignments.
Arine is a rapidly growing healthcare technology and clinical services company that uses data science and AI to optimize medication management and reduce healthcare costs. The company manages over 18 million lives, was ranked #236 on the 2024 Inc. 5000 list, and has a strong culture focused on innovation and patient outcomes.
Provide virtual or telephonic support to clients and healthcare professionals, documenting medical information requests and adverse events.
Conduct study compliance calls and enroll participants in educational seminars.
Maintain excellent quality and productivity standards while adhering to program scripts and guidelines.
Inizio Engage is a strategic, commercial and creative engagement partner specializing in healthcare. They employ over 7,000 experts in more than 20 countries, fostering a passionate, diverse, and global culture that challenges conventional thinking to improve health outcomes.
Perform remote order entry and CPOE evaluation and verification for acute-care hospitals.
Utilize clinical skills including monitoring, dosing, and reviewing patient medication therapy.
Collaborate with physicians and nurses to ensure continuity of care and regulatory compliance.
Cardinal Health distributes pharmaceuticals and provides medical products and data solutions for healthcare facilities. With over 45 years of experience, it is one of the largest employers of acute-care pharmacists in the United States, fostering an inclusive workplace that values diversity.
Review appeals for commercial and Part D plans, rendering determinations based on clinical guidelines and regulatory requirements.
Serve as a clinical reviewer and subject matter support, performing independent research and retrospective case reviews.
Assist with CMS client audits, investigate appeal determination questions, and support clinical training activities.
MedImpact delivers leading edge pharmaceutical and technology related solutions that improve the value of healthcare, providing transparency and choice. Privately-held for over three decades, it is one of the leading pharmacy benefit managers in America, committed to making prescription benefits understandable and accessible.
Accurately and timely review medication orders in a virtual environment.
Ensure safe medication use, regulatory compliance, and quality patient care.
Collaborate with healthcare teams through secure digital platforms to resolve medication-related issues.
Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. The organization prioritizes safety and provides an integrated system of healthcare experts committed to exceptional care.
Develop and deliver clinical messages to physicians, members, clients, and consultants.
Manage formulary strategy and clinical policy development across pharmacy and medical benefits.
Complete clinical prior authorizations and retrospective reviews.
Archimedes is a specialty drug management company that transforms the PBM industry by eliminating conflicts of interest and delivering rigorous clinical management. The company is expanding its team and focuses on cost management.
Provide medication management services inclusive of medication access, education, adherence, and comprehensive medication management for pediatric patients.
Act as liaison between the designated region and the medication management center of excellence, ensuring compliance with all regulatory authorities.
Document encounters in the electronic medical record and promote evidence-based, cost-effective medication management.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans, with a focus on compassion and an unwavering commitment to children with medical complexity.
Responsible for aiding in the delivery of clinical interventions and Medication Therapy Management (MTM) services for commercial and Medicare members.
Conducts telephonic and video chat outreach to complete analysis of members' medication regimens.
Performs outbound calls to members, fielding inbound calls, and facilitating communication regarding clinical programs.
Navitus is an alternative to traditional pharmacy benefit manager (PBM) models, committed to removing cost from the drug supply chain to make medications more affordable. The company has a team that celebrates diversity, fosters creativity, and encourages growth.
Coordinate care between physicians, patients, and pharmacies to facilitate access to specialty medications for complex disease states.
Review chart notes and perform utilization management, handling case assignments and documenting case progress.
Provide clinical expertise to prescribers and guide prescribing offices through the prior authorization process.
Archimedes is the industry leader in specialty drug management solutions, transforming the PBM industry to provide alignment, value, and transparency. The company achieves superior results for clients by eliminating conflicts of interest and delivering rigorous clinical management at the lowest net cost.
Provide patient care and advanced clinical pharmacy services in the ambulatory pharmacy space.
Collaborate with prescribers and manage medication therapy for direct patient care.
Document patient interactions across various electronic medical record platforms.
Saint Francis Hospital is a healthcare facility in Chicago, IL, part of Prime Healthcare SFIL Resurrection Medical Center. It offers a comprehensive benefits package and empowers staff with resources for growth and well-being.
Respond to patient inquiries regarding prescription drug plan coverage and fulfillment through the pharmacy, including answering inbound calls and conducting status checks.
Make outbound patient refill phone calls, coordinate medication refills including data entry and pharmacy claim adjudication, and resolve adjudication error messages.
Manage, organize, and update relevant data using database applications, identify trends, and participate in process improvement initiatives.
Shields Health Solutions is a healthcare company that partners with health systems to deliver specialty pharmacy services. They focus on patient engagement and medication adherence through integrated care models.