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 and process prior authorizations for biologics, oncology, and specialty therapies with timely and accurate completion.
Manage clinical documentation, submit and track authorization requests, and resolve issues with insurance providers.
Communicate effectively with patients, clinical staff, and insurance representatives to ensure compliance and workflow efficiency.
IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions like Rheumatoid Arthritis, Crohn's Disease, and Multiple Sclerosis. They are a rapidly growing company focused on patient comfort and employee empowerment, with core values of kindness, integrity, and continuous improvement.
Handle inbound pharmacy calls and make outbound refill reminders to guide patients through the refill process.
Coordinate medication refills including data entry, claim adjudication, and resolving patient and provider inquiries.
Collaborate with pharmacists, clinicians, and internal teams to ensure timely and accurate patient support and process improvements.
Shields Health Solutions is a healthcare company that focuses on patient engagement and medication refill support for pharmacies. The company is large enough to offer benefits like medical, dental, and vision insurance, 401(k) match, and paid parental leave, and emphasizes a collaborative and supportive culture.
Serve as a key point of contact between patients, providers, pharmacies, and pharmacy benefit teams to coordinate alternative medication sourcing solutions.
Identify and validate appropriate sourcing options for non-covered, high-cost, specialty, or limited-distribution medications.
Assist with cost comparisons, savings analyses, reports, invoices, and documentation related to pharmacy sourcing activities.
The company helps patients navigate complex pharmacy solutions and alternative medication sourcing pathways. They are a mission-driven organization focused on patient-centered service.
Provide expertise in prior authorization and implement the Inspire Prior Authorization Program.
Support patient intake, verify insurance, and manage prior authorization requests.
Train sites on program requirements and assist with appeals through External Medical Review.
Inspire Medical Systems is a medical device company dedicated to treating Obstructive Sleep Apnea with an innovative FDA-approved device. The company values a people-first culture, offering excellent benefits, 401k matching, and flexible time off, and is committed to diversity and patient outcomes.
Review and interpret clinician assessments for prior authorization approvals and care plan recommendations.
Monitor patient adherence across all sites and disease categories, focusing on oncology and specialty states.
Provide medication therapy management including regimen review, drug therapy changes, and patient coaching.
Shields Health Solutions provides integrated support to improve patient care quality. The company employs a team of licensed pharmacists and support staff, focusing on medication adherence and evidence-based care.
Assists with patient medication management and facilitates medication renewal requests.
Acts as a liaison between providers, patients, and pharmacies for prescriptions and prior authorizations.
Monitors prior authorization status and updates relevant parties throughout the process.
Mass General Brigham is a not-for-profit integrated health care system supporting patient care, research, teaching, and community service. They employ a diverse team of professionals including doctors, nurses, and tech experts, fostering a collaborative culture focused on exceptional care.
Act as the primary point of contact for incoming member calls, prior authorization inquiries, and ensure appropriate escalation of cases.
Efficiently triage incoming calls with professional phone etiquette from members, prescribers, and pharmacies with minimal support.
Meet all departmental goals including schedule adherence, attendance, and quality monitoring.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They are building trust in healthcare in the U.S. and deploying infrastructure for better care.
Respond to patient inquiries regarding prescription drug plan coverage and fulfillment through the pharmacy, including answering inbound calls and conducting status checks.
Make outbound patient refill phone calls, coordinate medication refills including data entry and pharmacy claim adjudication, and resolve adjudication error messages.
Manage, organize, and update relevant data using database applications, identify trends, and participate in process improvement initiatives.
Shields Health Solutions is a healthcare company that partners with health systems to deliver specialty pharmacy services. They focus on patient engagement and medication adherence through integrated care models.
Provides advanced pharmacy technical functions including IV therapy, chemotherapy preparation, and automated dispensing machine maintenance.
Manages supply levels, problem solves operational issues, and assists in training staff.
Enters prescriptions, completes reports, and ensures proper billing/coding under pharmacist supervision.
University of Utah Health is a patient-focused organization enhancing health through patient care, research, and education. They are a nationally ranked academic health system with five hospitals and eleven clinics, committed to values of compassion, collaboration, and integrity.
Conduct benefit investigations, insurance verification, and prior authorizations to secure timely patient access to therapies.
Manage patient case files, coordinate product ordering and shipment with pharmacies and prescribers.
Handle inbound inquiries, report adverse events, and educate stakeholders on program requirements.
Jobgether is a platform that uses AI-powered matching to connect candidates with hiring companies. They focus on efficient, objective candidate screening and share top-fitting shortlists with employers.
Proactively enroll patients in the Shields specialty pharmacy program through outbound calls, explaining the benefits of the service.
Review patient medical records to understand conditions and identify medications that require special handling or supplies.
Work flexible shifts within Eastern Time Zone hours, with occasional Saturday availability, and maintain confidentiality.
Shields Health Solutions provides specialty pharmacy services to health systems, helping patients access medications and support. They are a growing company focused on patient care, employee development, and a collaborative culture.
Manage the full Authorization process, from initial notification to determination and discharge, with detailed documentation in EMR and payer systems.
Verify patient eligibility and benefits, act as a liaison between hospital staff and health payers, and track pending authorizations for timely responses.
Maintain HIPAA compliance, escalate issues causing delays or denials, and manage workloads through accurate record keeping.
CorroHealth is a partner to healthcare providers, solving revenue cycle challenges through a mix of services, consulting, and technology. The company focuses on scalability and clinical expertise, building long-term careers by investing in employee development.
Lead and manage a team of Patient Support Associates, providing coaching and performance development.
Ensure medication access through refills, prior authorizations, and financial assistance.
Oversee pharmacy workflows, conduct system audits, and collaborate with hospital stakeholders.
Shields Health Solutions specializes in specialty pharmacy services and patient support for hospitals and clinics. The company fosters a culture of patient-focused care and team collaboration, with a remote and onsite workforce.
Grow the number of new patients filling at Shields partner pharmacies.
Lead, coach, and inspire a team of outreach coordinators.
Develop new patient engagement strategies and optimize outreach workflows.
Shields Health Solutions partners with health systems to build specialty pharmacy programs. They are a growing organization focused on operational excellence and a winning culture.
Verify patient insurance eligibility, benefits, and coverage prior to treatment.
Secure prior authorizations from insurance companies for scheduled medical services.
Maintain accurate records of authorizations, approvals, denials, and follow-up activities.
A-DTS is a healthcare services company focused on supporting patient access to care through insurance verification and authorization processes. The company is detail-oriented and emphasizes timely coordination in a remote work environment.
Support Veterans by answering pharmacy-related telephone inquiries, processing prescription requests, and delivering professional customer service.
Document patient interactions in CPRS, review prescription profiles, and refer clinical questions to pharmacists while maintaining HIPAA compliance.
Collaborate with healthcare teams to resolve medication-related issues and follow established pharmacy support workflows for first-contact resolution.
International SOS Government Medical Services provides healthcare, medical assistance, emergency response, and workforce support to improve patient care and operational readiness worldwide. Founded in 1984, the company operates in over 90 countries and supports government healthcare programs with a focus on veteran services.
Lead and manage a team of Patient Engagement members to ensure timely medication refill support and high-quality patient care.
Proactively manage support in assigned hospitals and clinics to ensure patients receive medications on time and service level goals are met.
Provide ongoing coaching, performance management, and professional development to drive team success and adoption of best practices.
Shields Health Solutions provides patient engagement and pharmacy support services to hospitals and clinics. It is a fast-growing company with a focus on high quality and accountability.