Review patient care notes for clinical data needed for prior authorization approvals.
Monitor patient adherence across all sites and disease categories, focusing on oncology and specialty-specific disease states.
Recommend alternative therapeutic drug regimens and disease-specific treatments according to guidelines.
Shields Health Solutions provides integrated pharmacy solutions to health systems. They focus on improving patient care and outcomes through specialized pharmacy programs and services. The company values innovation, collaboration, and a patient-centered approach.
Conduct high-volume outbound and inbound calls with patients, providers, and pharmacies.
Collaborate with patients to identify and remove barriers to medication adherence.
Accurately document all interactions, outcomes, and identified barriers in appropriate systems.
Aledade empowers independent primary care practices. They were founded in 2014 and have become the largest network of independent primary care in the country, with a collaborative, inclusive, and remote-first culture.
Conduct outbound telephone outreach to patients and engage patients in pharmacist-led consultations.
Serve as a liaison between patients and pharmacies to resolve medication barriers.
Collaborate closely with Care Management Pharmacists to support medication adherence initiatives.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. They are committed to improving patient outcomes and quality of life by delaying disease progression and shifting care to the home.
Collaborate with clinic teams to deliver hands-on patient care.
Process prior authorizations, resolve insurance issues, and support financial assistance.
Educate patients on pharmacy services and assist with specialty and retail prescriptions.
Shields Health Solutions is redefining patient care through specialty pharmacy. They are hiring motivated people and seem to have a good employee culture.
Engaging patients to deliver services on behalf of their health plan.
Managing a consistent volume of outbound and inbound calls.
Accurately documenting all interactions, interventions, and outcomes.
Arine is a healthcare technology and clinical services company that ensures individuals receive the safest and most effective treatments for their unique healthcare needs. They are a rapidly growing company backed by leading healthcare investors and collaborating with top healthcare organizations and providers.
Answer inbound calls and return voicemails from members, delivering exemplary customer service and support.
Troubleshoot and resolve prescription-related issues for members whose plans utilize CVS or Carelon as the PBM.
Coordinate with providers’ offices and retail/mail-order pharmacies as needed to resolve claims processing, prior authorization, and medication access issues.
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. They focus on cost containment strategies and driving down the cost of plans with innovative solutions. Point C provides equal opportunity in all employment practices.
Initiate communication to communities regarding expensive and non-formulary medication orders.
Keep detailed records of all orders that require communication to the community.
Review Medicare D rejections and prior authorizations, and coordinate with pharmacists or physicians.
Symbria Rx Services delivers patient-centered care to the geriatric population in senior-living and post-acute settings. As one of the few 100% employee-owned companies in healthcare, our business practices are guided strictly by the values to which our employee owners are committed to.
Communicate with insurance companies to facilitate medication approvals.
Navigate pharmacy systems to input data and prepare action plans.
Communicate with patients and clinician offices regarding medication access.
Shields Health Solutions focuses on improving patient care by removing barriers to medication access. They value creating a positive and inclusive work environment where employees can grow their careers.
Create innovative clinical programs, products, and services aimed at optimizing specialty and non-specialty drug management, support payer clients with their PBM and drug coverage decisions
Act as a detail-oriented advisor, using data-driven insights to evaluate pharmacy programs, identify trend drivers, outlier high-cost claims and drive improvements.
Monitor emerging market trends and drug pipelines to anticipate client impact and develop proactive solutions.
Pharmaceutical Strategies Group (PSG), an EPIC owned company, provides an integrated data and analytics platform that transforms member data into actionable intelligence, which drives improved management of drug spend and trend across both pharmacy and medical benefits. EPIC has over 60 offices and 3,000 employees nationwide.
Conduct timely post-discharge follow-up calls with patients after inpatient visits to assess needs and reinforce the plan of care.
Review and reconcile discharge medications and escalate any concerns to the Primary Care Provider.
Assist in coordinating and/or scheduling follow-up appointments with the patient's Primary Care Provider and/or specialists
Privia Health is a technology-driven physician enablement company that collaborates with medical groups, health plans, and systems. They optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care. The company is led by top industry talent and exceptional physician leadership.
Make outbound calls to eligible cancer survivors to introduce OncoveryCare and support them in scheduling care
Ensure patients have the information and tech support needed to access their first appointment
Work closely with the care team to troubleshoot issues and ensure a smooth experience for every patient
OncoveryCare is a virtual healthcare company rethinking physical and mental healthcare for cancer survivors. Their team includes cancer survivors, clinicians, and healthcare delivery experts who provide whole-person support for survivors throughout their cancer journey.
Conduct timely post-discharge follow-up calls with patients after inpatient visits to assess needs and reinforce the plan of care.
Review and reconcile discharge medications and escalate any concerns to the Primary Care Provider.
Assist in coordinating and/or scheduling follow-up appointments with the patient's Primary Care Provider and/or specialists.
Privia Health is a national physician platform transforming the healthcare delivery experience by providing tailored solutions for physicians and providers. They create value and secure the future through high-performance physician groups, accountable care organizations, and population health management programs.
Partner with payer clients as a trusted clinical advisor to design drug management strategies.
Assess and benchmark PBM and other industry vendor clinical programs.
Leverage medical and pharmacy data to assess program performance.
PSG (Pharmaceutical Strategies Group), an EPIC owned company, provides consultative guidance to payer clients in the drug management market. They have over 3,000 employees nationwide and foster a 50/50 culture between producers and the rest of the business, supporting collaboration and teamwork.
Performs complex secretarial and administrative duties.
Responsible for all clinic preparations and optimizing provider patient schedule.
Triages incoming calls, schedules patient appointments, and obtains pertinent medical information.
The University of Rochester is committed to education, research and making the world ever better. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning.
Serve as primary contact for patients, families, and providers
Schedule and coordinate medical appointments
Manage patient documentation and EMR updates
Pine Park Health is a value-based primary care practice redesigning how residents of senior living communities get or stay healthy and lead a life they love. They've expanded to over 185 communities across Arizona, California, and Nevada with investments from firms like First Round Capital and Google’s AI fund.
Coordinate care between VA and community providers, schedule appointments, and ensure Veterans receive timely and appropriate care.
Complete accurate scheduling using the Electronic Waiting List and VA scheduling systems, ensuring all appointments are made with the patient's input either in person or by phone.
Explain the VA's mandate to collect insurance information to Veterans, their families, and other eligible patients and update health insurance information.
CVP is an award-winning healthcare and next-gen technology and consulting services firm solving critical problems for healthcare, national security, and public sector clients. They cultivate a work environment that encourages fairness, teamwork, and respect among all associated, and are committed to maintaining a workplace where everyone can grow both personally and professionally.
Serve as the primary contact for patients, responding to inquiries with clarity, empathy, and efficiency.
Educate patients and providers on home infusion processes, including medication handling, storage, and administration protocols.
Schedule and confirm treatment appointments, coordinating with nursing agencies to ensure timely, accurate care delivery.
Leap is a benefits solution company and a pioneer in employer specialty pharmacy. They are reshaping how life-changing therapies are delivered and financed, ensuring patients get the treatment they need while employers get a fair deal.
Responsible for being the main point of contact for TPA (an external client) for new group implementations.
Ensure all requirements are documented in the standard project templates and tools.
Manage day to day coordination and task managements for a pod of Implementation Managers and/or Implementation Specialists to maintain workplace productivity.
SmithRx is a rapidly growing, venture-backed Health-Tech company aiming to disrupt the Pharmacy Benefit Management (PBM) sector. They accomplish this through technology and customer service, with a mission-driven and collaborative culture that inspires employees.
Maintains current information regarding surgery schedules for service site providers.
Triages and documents accurately telephone calls from patients including requests for medication refills, complaints, general information inquiries, and urgent health care concerns.
Schedules new patient appointments on line, and manually if necessary.
OHSU is Oregon's only public academic health center, caring for patients and leading groundbreaking research. As Portland's largest employer, they offer opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.
Investigate pharmacy-related concerns and issues arising before and after EHR Go-Lives, determining root causes and developing effective mitigation strategies
Actively engage with VA Medical Centers to support preparedness, readiness, and operational response during EHR deployment
Work closely with EHRM Solution Experts and stakeholders to resolve identified issues and drive timely, sustainable solutions
Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations, and enhanced service delivery. Founded in 2012, they have 300+ employees nationwide and specialize in applying technology, creativity, and human-centered services to optimize mission delivery.