Source Job

• Lead, coach, and develop Team Leads and Member Services Associates.
• Own performance outcomes for medication access including resolution time, pharmacy turnaround, quality scores, and member satisfaction.
• Serve as the primary operational partner for pharmacy vendors, owning escalation patterns, performance issues, and workflow alignment.

Maven is the world's largest virtual clinic for women and families with a mission to make healthcare work for all. They have raised more than $425 million in funding and have been recognized as a Time 100 Most Influential Company and a Fast Company Most Innovative Company.

Supports the clinical team through collaboration with prescribers and beneficiaries. Provides medication therapy management (MTM) services via triage of inbound calls. Documents services/activities in appropriate databases/software to ensure compliance.

Centene is committed to helping people live healthier lives by providing access to high-quality healthcare, innovative programs and a wide range of health solutions.

• Oversee daily operations related to patient medication refill administration and inbound pharmacy patient inquiries.
• Manage clinic level and/or hospital service level escalations; build and action plan for resolution.
• Work with leadership to develop documented staffing plans and staffing forecasts that align with the needs of the region and productivity targets.

Shields Health Solutions is a fast-growing company in the specialty pharmacy management services.

• Review and audit prescriptions and delivery slips for completion and accuracy.
• Collaborate with clinicians in specialty clinics to ensure seamless medication management and adherence.
• Educate patients on how pharmacy services enhance care and improve outcomes.

Shields Health Solutions is a fast-growing leader in specialty pharmacy management services, dedicated to making a real difference in patients’ lives.

• Provide one-on-one counseling to patients and caregivers on medication use, adherence, side effects, and cost-effective options.
• Conduct comprehensive medication reviews and reconciliation, particularly for patients with chronic conditions, multiple medications, or recent hospitalizations.
• Partner with care managers, health center pharmacists, and primary care providers to support patients in meeting treatment goals, including diabetes, hypertension, COPD, and other chronic conditions.

Medical Home Network (MHN) partners with Federally Qualified Health Centers (FQHCs) nationwide to transform care. They help FQHCs succeed in value-based care through technology, care model innovation, and strong partnerships, expanding reach to enhance care for their patients.

Oversee a team of pharmacy technicians in the prior authorization process. Analyze data and provide recommendations to maximize team agility and performance. Generate and deliver reports on technician metrics to stakeholders.

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans.

• Support the AVP of Medical Cost Containment in the implementation, process improvement, and optimization of clinical programs.
• Manage a team of 8 pharmacists through a remote setting, overseeing a countrywide prior authorization program specific to workers compensation claims.
• Monitor, analyze, and trend clinical program data to assist in the development, implementation, and driving of key initiatives.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected.

• Provide integrated support to patients and physicians, taking a hands-on approach to improve patient care quality.
• Develop personalized relationships with patients and prescribers to enhance medication adherence and promote evidence-based care.
• Monitor patient adherence across sites and disease categories, focusing on oncology and other specialty-specific conditions.

Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment.

Provide medication management for individuals, including medication reconciliation, dose optimization, and medication adherence counseling. Collaborate with the interdisciplinary care team to develop individualized care plans that align with evidence-based guidelines. Monitor and evaluate medication regimens to ensure clinical criteria are met, including therapeutic goals, adverse effects, and drug interactions.

Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type.

Lead a technical support team to ensure the seamless operation of the Aledade App and its data interfaces. Manage ticket lifecycles and optimize systems. Provide escalation support, implement workflow solutions, and supervise support processes to enhance operations through improvements and automation.

Aledade empowers independent primary care practices, health centers and clinics to deliver better care and thrive in value-based care.

• Establish and direct the strategic vision for the Imagine Pediatrics centralized call center.
• Lead a team of engagement associates that enroll attributed eligible patients into the clinical program.
• Partner with Product, Engineering, and Data teams to inform the technical infrastructure.

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, enhancing existing care teams with compassion and an unwavering commitment.

• Review clinical documentation to determine medical necessity and program compliance.
• Decide on authorization or denial of prior approval requests via telephone.
• Provide pharmaceutical expertise to advisory board’s clinical workgroups.

UMass Chan Medical School welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.