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.
Work collaboratively with physicians, nurses, other healthcare providers, and patients to optimize drug therapy and outcomes using evidence-based standards of care.
Responsible for providing effective, efficient and accurate ambulatory pharmaceutical care to achieve organizational, patient care, and quality measure goals and objectives.
Prescribe pharmaceutical agents as outlined in the approved collaborative drug therapy management agreement including initiating, adjusting, and discontinuing drug therapy.
Dignity Health Medical Foundation, established in 1993, provides comprehensive health care services throughout California. They are an affiliate of Dignity Health, one of the largest health systems in the nation, striving to create purposeful work settings where staff can provide great care.
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.
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 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.
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.
Provide comprehensive medication management and drug‑level assessments.
Partner with physicians and interdisciplinary teams to order individualized care plans.
Monitor therapy effectiveness and safety, and provide recommendations to operations.
Shields Health Solutions is redefining patient care through health-system integrated specialty pharmacy. They are dedicated to elevating patient care at a nationally recognized Academic Medical Center and building meaningful relationships with patients and providers.
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.
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 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.
Directly lead and manage a team of Patient Support Associates to ensure medication adherence or timely prior authorization.
Proactively manage support in assigned hospitals and/or clinics to ensure patients receive medications on-time.
Provide front-line supervision and ongoing coaching and performance management to Patient Support team.
Shields Health Solutions is a specialty pharmacy management service provider. They are a fast-growing company that values motivated self-starters with a positive outlook and a focus on high-quality work.
Support daily pharmacy operational workflows and administrative tasks to ensure timely and accurate prescription processing.
Provide frontline operational support to clinicians and internal teams for routine pharmacy workflow questions and requests.
Collaborate with the CX team to assist with basic prescription-related member issues and inquiries.
Lifeforce is the world's largest longevity medicine program. They bring together diagnostics, clinical experts, health coaches, and customized protocols to help people understand and optimize their bodies, functioning now and decades to come. They seem to have a modern and proactive company culture.
Serve as primary point of contact for specialty pharmacy patients from enrollment through therapy adherence, handling benefits verification and prior authorization.
Manage a caseload independently, perform outbound calls, and coordinate with pharmacy partners to ensure accurate therapy and shipment status.
Maintain strict patient confidentiality per HIPAA, recognize and report adverse events, and follow program-specific protocols.
Caretria provides patient support services for specialty pharmacy patients, focusing on enrollment, benefits verification, and care coordination. The company values empathy, urgency, and accuracy, and offers a comprehensive benefits package to its employees.
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.