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.
Establish and maintain scientific partnerships with Key Opinion Leaders in oncology, rheumatology, and immunology.
Provide non-promotional scientific discussions on biosimilars including mechanism of action, safety, and efficacy.
Contribute to medical strategy by generating insights and supporting launch readiness.
Dr. Reddy's Laboratories is a global pharmaceutical company providing innovative and affordable healthcare solutions, from prescription generics to biopharmaceuticals. The subsidiary fosters a diverse, inclusive, and collaborative culture committed to sustainability and patient health.
Contact physician offices for refill authorizations and verify orders.
Process new and refill prescriptions, ensuring accurate data entry and maintaining productivity.
Answer incoming calls promptly and provide high standard of customer service.
Symbria Rx Services is a 100% employee-owned healthcare company that provides patient-centered care to the geriatric population in senior-living and post-acute settings. For over 20 years, they have been delivering an outstanding work environment for talented employees.
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.
Build and maintain relationships with key opinion leaders (KOLs) and healthcare professionals within assigned region.
Serve as subject matter expert at key medical conferences, advisory boards, and internal meetings.
Identify and engage with healthcare stakeholders to communicate clinical and scientific data effectively.
Mineralys Therapeutics is a clinical-stage biopharmaceutical company developing medicines for hypertension and related comorbidities. They are a fully remote company with a growing Medical Affairs team.
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.
Provide medication management services inclusive of medication access, education, adherence, and comprehensive medication management for pediatric patients.
Act as liaison between the designated region and the medication management center of excellence, ensuring compliance with all regulatory authorities.
Document encounters in the electronic medical record and promote evidence-based, cost-effective medication management.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans, with a focus on compassion and an unwavering commitment to children with medical complexity.
Collaborate with engineering, product, and data teams to develop and maintain the software platform and improve clinical algorithms.
Serve as a subject matter expert, triage bugs, and respond to clinical questions from providers, users, and leadership.
Conduct user acceptance testing, prepare customer demonstrations, and develop intervention strategies to optimize medication utilization.
Arine is a healthcare technology and clinical services company focused on optimizing medication management through a SaaS platform that combines data science, machine learning, and clinical expertise. Backed by leading healthcare investors, the company manages over 18 million lives and was ranked 236 on the 2024 Inc. 5000 list, fostering a collaborative and mission-driven culture.
Coordinate care between physicians, patients, and pharmacies to facilitate access to specialty medications for complex disease states.
Review chart notes and perform utilization management, handling case assignments and documenting case progress.
Provide clinical expertise to prescribers and guide prescribing offices through the prior authorization process.
Archimedes is the industry leader in specialty drug management solutions, transforming the PBM industry to provide alignment, value, and transparency. The company achieves superior results for clients by eliminating conflicts of interest and delivering rigorous clinical management at the lowest net cost.
Review appeals for commercial and Part D plans, rendering determinations based on clinical guidelines and regulatory requirements.
Serve as a clinical reviewer and subject matter support, performing independent research and retrospective case reviews.
Assist with CMS client audits, investigate appeal determination questions, and support clinical training activities.
MedImpact delivers leading edge pharmaceutical and technology related solutions that improve the value of healthcare, providing transparency and choice. Privately-held for over three decades, it is one of the leading pharmacy benefit managers in America, committed to making prescription benefits understandable and accessible.