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 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 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.
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.
Review and evaluate medication orders for accuracy, appropriateness, and safety.
Provide medication counseling and conduct patient care assessments to optimize drug therapy.
Collaborate with healthcare providers and participate in interdisciplinary team to monitor outcomes.
Shields Health Solutions is a healthcare company specializing in specialty pharmacy and therapy management services. They are an equal opportunity employer committed to diversity and inclusion.
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 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.
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.
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.
Collaborate with engineering, product, and data teams to develop and maintain the software platform and improve clinical algorithms.
Serve as a subject matter expert, triage bugs, and respond to clinical questions from providers, users, and leadership.
Conduct user acceptance testing, prepare customer demonstrations, and develop intervention strategies to optimize medication utilization.
Arine is a healthcare technology and clinical services company focused on optimizing medication management through a SaaS platform that combines data science, machine learning, and clinical expertise. Backed by leading healthcare investors, the company manages over 18 million lives and was ranked 236 on the 2024 Inc. 5000 list, fostering a collaborative and mission-driven culture.
Lead the transformation of PDMI's Account Management function into a proactive, strategic, insight-driven client partnership model.
Develop and implement a scalable Account Management operating model including role structure, account segmentation, and measurable performance expectations.
Drive executive-level client engagement strategies and ensure alignment across Product, IT, Operations, and other internal teams.
PDMI provides pharmacy data processing and flexible, scalable solutions for private label PBMs, health plans, and hospital systems. Founded in 1984, the company was voted Best Employer in Ohio for the 5th consecutive year in 2025 and fosters a collaborative, innovative environment.
Conduct research and quality assurance for drug and biological policies.
Write business logic and translate industry references into Cotiviti policy.
Mentor new team members and assist with customer inquiries regarding clinical rules.
Cotiviti is a healthcare analytics company that provides clinical coding and policy solutions for health plans. They focus on maintaining accurate medical policy libraries and employ a global team, offering benefits like PTO and paid family leave.
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.
Design and configure prior authorization criteria, decision trees, and authorization parameters within the PA system.
Perform quality assurance and quality control reviews to ensure clinical intent and regulatory compliance.
Collaborate with internal teams and external clients to support delegated PA services and system optimization.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. The company is a public benefit corporation focused on rebuilding trust in healthcare in the U.S., with a culture that emphasizes collaboration and client support.
Collect and document clinical information from providers, pharmacies, and members.
Assist pharmacists with utilization management and appeals processing.
Communicate with prescribers and pharmacies regarding authorization status and coverage requirements.
The OccuNet Company is an innovative company striving to reduce the cost of healthcare through negotiations-driven levers and an experience-centric approach. We have an ambitious vision and are growing quickly, with a tight-knit culture based on the outward mindset philosophy emphasizing empathy and mutual respect.