Leads specialty pharmacy services and medication access for ambulatory clinics across the region.
Supervises daily operations, workflow optimization, and staff development for Specialty Pharmacy Care Coordinators.
Collaborates with management on strategic initiatives, accreditation, and regulatory compliance.
Baptist Health is a full-spectrum health system dedicated to improving community health. Founded in 1924, it employs over 24,000 people and includes 10 hospitals and more than 470 points of care.
Lead operational execution for pharmacy services, ensuring efficiency, profitability, and patient care excellence.
Mentor staff, manage client relationships, and oversee compliance with laws and accreditation standards.
Handle staffing, scheduling, inventory control, and training to optimize pharmacy workflows.
VytlOne is a pharmacy services and technology company that enables pharmacy care, with a focus on health system pharmacies. With nearly 100 years of experience and 1,000 employees, it combines Fortune 500 stability with startup energy and promotes a culture of teamwork and flexibility.
Perform retrospective and concurrent Quality Assurance audits of inpatient encounters for accuracy and compliance.
Identify areas of educational opportunities and provide feedback to Coding Leadership.
Audit scope includes both government and commercial payors including RAC and ACHA.
Baptist Health is a faith-based, not-for-profit health system providing preventive and specialty care in Northeast Florida through over 200 locations and six hospitals. Recognized as a top workplace and most preferred provider for more than 25 years, it was recently named a top employer for diversity by Forbes.
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.
Oversee hospice intake compliance and execute clinical audit activities across the organization.
Conduct pre-bill chart audits to ensure Medicare regulatory compliance and documentation accuracy.
Collaborate with clinical and operational teams to strengthen audit readiness and support revenue cycle efficiency.
Ennoble Care is a mobile primary care, palliative care, and hospice service provider operating across multiple states. The company prioritizes high-quality care for chronic conditions and limited mobility, embodying the motto "To Care is an Honor."
Support implementation and operation of the Compliance Program, including conflict of interest, compliance hotline, and regulatory reviews.
Serve as liaison for compliance questions and incidents, and recommend corrective actions and education opportunities.
Work with all levels to ensure internal controls provide accurate, complete, and compliant processes.
Cooper University Health Care is a healthcare organization dedicated to providing extraordinary health care and fostering clinical innovation. It offers competitive compensation, comprehensive benefits, and opportunities for professional growth.
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.
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.