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.
Evaluate and review all appeals requests to render coverage determinations based on clinical criteria and medical necessity.
Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to providers.
Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times.
Judi Health offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi® the industry’s leading proprietary Enterprise Health Platform (EHP). Together with our clients, they’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.
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.
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.
Complete monthly utilization management and appeals performance and process audits.
Present audit results to leadership to address issues.
Assist management in identifying, evaluating, and mitigating risks.
Judi Health provides a comprehensive suite of solutions for employers and health plans. They offer full-service health benefit management solutions and consolidate all claim administration-related workflows in one scalable, secure platform.
Lead and oversee Prior Authorization Operations across all lines of business.
Manage Prior Authorization processes ensuring optimal efficiency and compliance.
Drive cross-functional collaboration to align with organizational goals.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They are rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.
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.
Evaluate patient data in Arine’s software platform and prepare reports concerning patient care and team progress.
Complete efficient medication reviews and counseling appointments.
Develop intervention strategies to optimize medication utilization and achieve quality measures.
Arine is a rapidly growing healthcare technology and clinical services company with a mission to ensure individuals receive the safest and most effective treatments.
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.