Communicate with insurance companies and clinician offices to facilitate medication prior authorizations.
Assist patients with financial assistance resources and navigate pharmacy systems for claims processing.
Support medication adherence through direct patient communication and accurate documentation.
Shields Health Solutions is a healthcare solutions company specializing in specialty pharmacy services. The company fosters a collaborative culture focused on patient care and operational excellence.
Submit and track prior authorization requests across multiple insurance payers
Gather and review clinical documentation required to support authorization requests
Follow up with payers on pending requests and monitor authorization status through resolution
Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. The company operates with a fully remote workforce and emphasizes a detail-oriented, collaborative culture.
Facilitate medication approvals by communicating with insurance companies and healthcare providers regarding prior authorizations.
Navigate pharmacy systems to enter data, adjudicate claims, process refills, and document patient interactions.
Assist patients with insurance claims, medication access challenges, and promote adherence through phone support.
Shields Health Solutions is a healthcare company dedicated to helping patients access life-changing medications through prior authorization and financial assistance support. They foster a collaborative, patient-focused culture with opportunities for professional growth in a fully remote setting.
Complete assigned medication utilization reviews and medical necessity appeals for commercial and governmental clients.
Provide peer-to-peer support to physicians and prescribers regarding clinical programs and utilization review decisions.
Actively participate in developing utilization management criteria and clinical policy revisions.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including pharmacy benefit management and health benefit management. They are rebuilding trust in healthcare in the U.S. and deploying infrastructure for better care, but no specific employee size or culture details are provided.
Communicate directly with insurance companies to facilitate medication approvals and prior authorizations.
Navigate pharmacy systems to enter data, adjudicate claims, and document patient interactions across multiple databases.
Provide compassionate phone support to patients, helping them manage refills, medication adherence, and pharmacy-related questions.
Shields Health Solutions partners with health systems to provide specialty pharmacy services, helping patients access complex medications. As a growing organization, they emphasize a collaborative culture and patient-centered care, employing pharmacy professionals dedicated to improving medication adherence and health outcomes.
Review and evaluate medication orders for accuracy, appropriateness, and safety.
Provide medication counseling to patients, addressing questions and concerns.
Collaborate with healthcare providers to develop and monitor medication therapy plans.
Shields Health Solutions provides pharmaceutical care services, specializing in therapy management programs for patients with conditions like diabetes and weight management. The company focuses on remote collaboration with healthcare professionals to ensure safe and effective medication therapies.
Act as a trusted liaison between patients and healthcare providers, providing expert guidance on pharmacy benefits.
Own patient cases end-to-end, resolving coverage, prior authorization, and appeals issues.
Collaborate with stakeholders to ensure members navigate the healthcare system with confidence.
AffirmedRx is a pharmacy benefit management company on a mission to improve healthcare outcomes by bringing clarity, integrity, and trust to the industry. They are a mission-driven organization committed to patient-centered care and ethical practices.
Operate within pharmacist-led clinical programs focused on chronic disease, quality improvement, and medication optimization.
Conduct Medication Reconciliation, Medication Therapy Management, and Comprehensive Medication Reviews.
Collaborate with interdisciplinary teams, including physicians and health coaches, to develop patient-specific action plans.
Vytalize Health is a value-based healthcare organization that partners with providers to improve patient outcomes and reduce costs. They are a rapidly growing company with a culture focused on collaboration and innovation.
Conduct utilization review to determine medical necessity of admission and continued stay using established criteria.
Collaborate with payers to secure authorization and work with multidisciplinary teams to reduce length of stay and readmissions.
Provide clinical data for denial management, appeal letter writing, and trend identification to improve processes.
OHSU is Oregon's only public academic health center, providing patient care, groundbreaking research, and training health professionals. As Portland's largest employer, we offer diverse opportunities in a system of hospitals and clinics, committed to building an anti-racist, multicultural institution.
Support the Pharmacotherapy Clinic by assisting pharmacists with patient communication and care coordination.
Conduct patient check-ins, coordinate appointments, and track labs to ensure timely follow-up.
Maintain documentation in Epic and perform clerical tasks to support clinical operations.
Shields Health Solutions provides specialty pharmacy services to health systems and hospitals. They focus on patient-centered care and offer a collaborative, inclusive work environment.
Perform clinical reviews for medical necessity, level of care, and authorization compliance.
Prepare and submit high-quality appeals related to DRG downgrades and clinical validation denials.
Apply payer-specific guidelines and document review findings accurately in designated systems.
CorroHealth helps clients exceed their financial health goals through scalable revenue cycle solutions and clinical expertise. The company builds long-term careers by investing in team members' professional development and personal growth.
Verifies patient insurance coverage and submits prior authorizations to insurance plans.
Troubleshoots prior authorization submissions and prescription processing with healthcare providers.
Documents activities and works with Customer Support team to ensure patient success.
PHIL is a health-tech startup pioneering the first Software Therapy Deployment Platform for Specialty Pharmaceuticals. The company employs over 120 individuals and expects to double its employee base in the coming year.
Reviews payor denials and audits for potential lost revenue and writes comprehensive appeal arguments using clinical criteria.
Functions as a hospital liaison with external third-party payors and works with Physician advisor team to facilitate appeals.
Monitors and reports payor trends to management, ensuring compliance with regulatory and accrediting requirements.
Jefferson Health is a nationally ranked not-for-profit health care system reimagining health care and higher education to create unparalleled value. With more than 65,000 employees, it serves patients through millions of encounters annually at 32 hospital campuses and over 700 outpatient locations in the greater Philadelphia region, Lehigh Valley, and southern New Jersey.
Counsel patients via telephonic outreach on medication adherence and make evidence-based recommendations.
Perform focused clinical chart reviews to inform patient interventions and document commitments.
Escalate complex cases to prescribers and meet performance goals such as STARs and HEDIS.
Aledade is a public benefit corporation dedicated to empowering independent primary care practices. Founded in 2014, it has become the largest network of independent primary care in the country, fostering a collaborative, inclusive, remote-first culture.
Manage insurance authorizations for clients in PHP and IOP programs, including pre-certifications and concurrent reviews.
Verify benefits, obtain Single Case Agreements, and build medical necessity cases using ASAM, LOCUS, and CALOCUS criteria.
Maintain accurate authorization, denial, and SCA records and prepare appeals on denied authorizations.
AWA and PRC are dual behavioral health organizations operating PHP and IOP programs across South Florida. They exist to serve clients and families at their most critical moments.
Provide expert opinions to APS and its clients regarding the clinical value of drugs to payers and how they will be perceived and managed.
Conduct drug information research to understand payer lines of business and perceptions of new drugs and indications.
Prepare Word documents, PowerPoint slides, or other formats describing commercial viability and payer coverage management for new business development.
Advantage Point Solutions (APS) is a pharmaceutical consulting agency that partners with manufacturers and payers to deliver groundbreaking formulary and contracting strategies. With over 20 years of experience, the team of knowledgeable professionals focuses on creating value for both sides of the market.
Serve as a liaison between patients, providers, and internal teams to coordinate alternative pharmacy sourcing.
Identify and verify sourcing channels for non-covered or high-cost medications.
Track sourcing outcomes, maintain compliance, and support patient access to medications.
CommuniCare Family of Companies is a national leader in post-acute care, providing person-centered services for chronically ill or complex condition patients. With over 19,000 employees across 150+ facilities in six states, it is a family-owned company that values family, heart, and exceptional service.
Review Home Health prior authorization requests using CMS guidelines and clinical judgment.
Lead and mentor the Home Health UM nursing team, ensuring quality and compliance.
Collaborate with cross-functional partners to optimize care and improve utilization.
Clover Health provides high-quality, affordable healthcare for America's seniors by combining data, technology, and preventive care. They are a mission-driven team with diverse expertise, focused on improving members' lives through innovation and empathy.
Applies approved utilization criteria to monitor appropriateness of admissions and continued stay reviews.
Communicates with third-party payers for initial and concurrent clinical review to ensure medical necessity.
Tracks length of stay and resource utilization to identify at-risk patients and supports appeals on denied cases.
University of Utah Health is a patient-focused healthcare organization dedicated to enhancing health and well-being through patient care, research, and education. It is a nationally ranked Level 1 Trauma Center with five hospitals and eleven clinics, fostering a culture of collaboration, excellence, and respect.
Remote order entry and CPOE order evaluation and verification
Clinical medication dosing and review of patient profiles and lab values
Physician and nursing consultations to ensure continuity of care
Cardinal Health is a distributor of pharmaceuticals, medical products, and provider of performance and data solutions for healthcare facilities. With over 50 years of experience, they are a large employer of acute-care pharmacists in the US and foster an inclusive workplace.