Reviews Part D coverage determinations and appeals to ensure clinical appropriateness and compliance with CMS regulations.
Conducts Medication Therapy Management (MTM) activities, including comprehensive medication reviews and targeted interventions for high-risk members.
Supports pharmacy quality improvement initiatives aligned with Medicare Star Ratings and HEDIS measures.
Alignment Health is a healthcare company focused on serving seniors and the chronically ill through Medicare Advantage plans. The company is fast-growing with a team of passionate people dedicated to transforming senior care.
Provide expert-level medication therapy consultations to patients and providers, including Medication Therapy Management (MTM) services like Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs).
Collaborate with the Engineering team and leadership to improve Arine's software platform and guide the Clinical Support team, while managing a consistent volume of patient interactions.
Meet individual and team performance metrics related to outreach, engagement, documentation quality, and clinical outcomes, and adapt to evolving clinical projects and assignments.
Arine is a rapidly growing healthcare technology and clinical services company that uses data science and AI to optimize medication management and reduce healthcare costs. The company manages over 18 million lives, was ranked #236 on the 2024 Inc. 5000 list, and has a strong culture focused on innovation and patient outcomes.
Responsible for aiding in the delivery of clinical interventions and Medication Therapy Management (MTM) services for commercial and Medicare members.
Conducts telephonic and video chat outreach to complete analysis of members' medication regimens.
Performs outbound calls to members, fielding inbound calls, and facilitating communication regarding clinical programs.
Navitus is an alternative to traditional pharmacy benefit manager (PBM) models, committed to removing cost from the drug supply chain to make medications more affordable. The company has a team that celebrates diversity, fosters creativity, and encourages growth.