Verify insurance, obtain benefits, calculate estimates, and secure prior authorizations for outpatient services.
Act as liaison between payers and clinic staff; follow up on denied or delayed authorizations.
Maintain detailed documentation and resolve issues with physicians, nurses, and financial advocates.
University of Utah Health is a patient-focused organization enhancing health through care, research, and education. It operates five hospitals and eleven clinics with a culture of collaboration, excellence, leadership, and respect.
Process referrals and prior authorizations, ensuring accurate and timely documentation.
Collaborate with clinical teams, physician offices, and insurance companies to resolve authorization issues.
Monitor denial reports, manage referral tracking, and communicate decisions to providers, staff, and patients.
Baystate Health is an integrated healthcare system serving western Massachusetts. With 12,000 employees and a community-focused culture, it includes five hospitals and offers career growth.
Review and process prior authorization requests for various medications.
Communicate prior authorization criteria to providers and act as a help desk.
Process requests via phone, fax, and web submission while maintaining HIPAA compliance.
Lumicera Health Services is a specialty pharmacy focused on optimizing patient well-being through transparency and stewardship. It fosters a diverse and creative work environment as part of the Navitus organization.
Serve as clinical subject matter expert and operational driver for prior authorization.
Build tools, drive process improvements, and mentor peer pharmacists on clinical protocols.
Handle complex escalations, appeals, and cross-functional collaboration to scale clinical operations.
SmithRx is a venture-backed Health-Tech company disrupting the PBM market with cutting-edge technology. Since 2016, we have onboarded hundreds of thousands of members and pride ourselves on a mission-driven, collaborative culture.
Review and respond to phone and fax inquiries from members, providers, and pharmacies for prior authorization.
Use multiple applications and follow procedures to accurately document and resolve inquiries.
Provide excellent customer service and meet or exceed call center metrics.
The Cigna Group is dedicated to improving the health and vitality of those we serve through Cigna Healthcare and Evernorth Health Services. We are a major healthcare organization focused on enhancing the lives of our clients, customers, and patients.
Process medication prior authorizations and support ambulatory care pharmacy services to improve patient access to medications.
Research and identify potential medication access options, including prior authorization, drug assistance programs, copay discount cards, and foundation grants.
Serve as a liaison between patients, providers, pharmacies, and assistance programs, managing renewals and eligibility.
Dignity Health Medical Foundation is a California nonprofit public benefit corporation that provides comprehensive health care services through its care centers. It is an affiliate of Dignity Health, one of the largest health systems in the nation, with a culture centered on purposeful work, growth, and excellence in care.
Supervises representatives, manages performance, and provides feedback through side-by-side and recorded call reviews.
Handles escalated calls, partners with business units, and coordinates team schedules to maximize efficiency.
Monitors volumes for pending queues and ensures timely processing of prior authorization forms.
PharMerica is a long-term care pharmacy services provider that supplies medications, clinical support, and pharmacy management to healthcare organizations across the United States. It operates as part of BrightSpring Health Services, combining personalized care with the resources of a national network.
Verify insurance eligibility, coverage, and behavioral health benefits for new and existing patients.
Coordinate prior authorizations, referrals, and coverage resolution with insurance carriers and internal teams.
Manage high-volume requests through EHR systems with strong attention to detail and problem-solving.
Blackbird Health is a clinician-founded provider of virtual and in-person mental health services for children across Pennsylvania, Virginia, New Jersey, and Maryland. The team is collaborative, supportive, and innovative, taking a whole-child approach to care.
Leads enterprise authorization operations with direct impact on revenue protection, patient access, and reimbursement performance.
Manages a team responsible for insurance verification, pre-authorization, and timely processing of assigned services.
Collaborates with billing, registration, revenue cycle, clinical, and administrative teams to reduce preventable payment denials.
The partner company is a healthcare organization focused on revenue protection, patient access, and reimbursement performance. They provide a collaborative and mission-driven environment for teams working across complex healthcare operations.
Coordinates utilization review and prior authorization requests, ensuring accurate entry into the UM platform.
Provides customer service to providers and members, confirming benefits and answering authorization questions.
Facilitates communication between reviewers, hospitals, and physicians to ensure timely decisions.
University of Utah Health Plans is a patient-focused organization that enhances health through patient care, research, and education. It is part of a nationally ranked academic medical center with five hospitals and eleven clinics, fostering a culture of collaboration and excellence.
Review prior authorization requests and make evidence-based decisions using clinical guidelines.
Ensure compliance with federal, state, and internal regulations while accurately documenting clinical decisions.
Provide clear, empathetic support to members, prescribers, and pharmacies, staying current with prescribing guidelines and regulatory changes.
SmithRx is a rapidly growing, venture-backed Health-Tech company that disrupts the expensive Pharmacy Benefit Management (PBM) sector with a next-generation drug acquisition platform. Since 2016, they have onboarded hundreds of thousands of members and pride themselves on a mission-driven, collaborative culture guided by values of Integrity, Courage, and Together.
Manage, triage, and assign clinical pharmacy referrals to the appropriate clinical pharmacy team member.
Schedule patient/caregiver appointments and prepare charts for pharmacist-driven clinical programs.
Communicate with pharmacies, insurance companies, and internal teams to resolve medication access barriers.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs, delivering 24/7 virtual-first and in-home medical, behavioral, and social care. The company is guided by values like Children First, Earn Trust, and Embrace Humanity, fostering a culture of empathy, innovation, and diverse perspectives.
Maintain clinical drug lists and prior authorization documents, resolve drug list and benefit setup questions, and prepare reports and client business review materials.
Investigate claim rejections related to drug list platform configuration and coordinate with pharmacists and operational teams to meet deadlines.
Identify opportunities to improve accuracy and efficiency through technology, automation, and AI-enabled tools.
Prescryptive is a healthcare technology company enabling the direct access marketplace for prescription drugs. As an Equal Opportunity Employer, the company values bold aspirations and a passion for improving consumer health and wellbeing.
Prepare and manage provider credentialing and payer enrollment applications for commercial, Medicare, Medicaid, and other health plans.
Maintain accurate provider files including CAQH profiles, NPI information, state licenses, and other required documentation.
Monitor credentialing statuses through payer portals and communicate updates to leadership and providers.
Modena Health is a physician-led, hospitality-focused medical practice specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona and plans for national expansion. The company values collaboration, positivity, and growth, aiming to hire great people and help them find meaning in its mission.
Perform patient-specific medication reviews and develop recommendations for medical drug utilization management and Medication Therapy Management.
Resolve medication and pharmacy issues for members triaged from Member Services or other departments.
Act as subject matter expert for audits, quality improvement, and LEAN projects.
IEHP is a not-for-profit health plan dedicated to healing and inspiring the human spirit by providing quality healthcare services to members. They emphasize a supportive culture with career growth and wellness programs for their team.
Conduct high-volume outbound and inbound calls with patients, providers, and pharmacies to support medication adherence.
Collaborate with patients to identify and remove barriers to medication adherence, escalating clinical issues to pharmacists.
Document interactions and coordinate with providers and pharmacies to ensure prescription refills occur as scheduled.
Aledade PBC is a public benefit corporation that empowers independent primary care practices to thrive in value-based care. Founded in 2014, it has become the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Manage end-to-end drug prior authorization and claims cases, assessing requests against clinical guidelines and plan provisions.
Communicate authorization outcomes clearly to members, providers, and internal stakeholders while resolving escalated and complex scenarios.
Serve as a subject matter expert to support teams, training, and continuous improvement initiatives.
The hiring company operates in the insurance and benefits sector, managing complex drug prior authorization and claims cases. It is a global organization with a collaborative culture that values flexibility, continuous improvement, and employee well-being.
Triage incoming phone calls from members and pharmacies with professional etiquette.
Identify, document, and escalate member and pharmacy concerns to appropriate teams.
Ensure first-call resolution and exceptional customer care with genuine compassion.
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. We are an intelligence platform powering benefits plans for millions of Americans, delivering the healthcare we all deserve.
Handle inbound calls, chats, emails, and faxes from healthcare providers, resolving questions on authorizations, claims, and provider services.
Document each interaction, research issues, and ensure accurate, timely follow-up with providers.
Guide providers through processes like checking authorization status, submitting claims, and navigating the provider portal.
Curana Health is a national leader in value-based care, offering senior living and skilled nursing facilities solutions such as on-site primary care, ACOs, and Medicare Advantage plans. Founded in 2021, it serves 200,000+ seniors in 1,500+ communities across 32 states with 1,000+ clinicians.
Address patient and DPOA inquiries via phone and patient portal, and assist with scheduling follow-up appointments.
Manage electronic health records, maintain patient rosters, and facilitate provider orders and prior authorizations.
Collaborate with the Curana interdisciplinary care team and handle incoming calls professionally.
Curana Health is a national leader in value-based care for senior living, offering on-site primary care and Medicare Advantage plans. Founded in 2021, it has grown to serve 200,000+ seniors in 1,500+ communities, with a team of 1,000+ clinicians and staff, ranking #147 on the Inc. 5000.