Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
Conduct member outreach, education, and follow-up to support adherence and understanding
Point C is a national third-party administrator (TPA) delivering customized self-funded benefit programs with local market presence. They focus on cost containment strategies with innovative solutions. They are driven by a clear and impactful mission.
Responsible for the coordination of services for members meeting established criteria, emphasizing education/self-management and promoting quality care and cost-effective outcomes.\n- Uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, and evaluate Member status.\n- Addresses medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs, providing counseling and referrals to community/local/state programs.
Capital Blue Cross is committed to providing excellent service to both its team and the community. Employees have consistently voted it as one of the “Best Places to Work in PA”, which indicates a positive and supportive company culture.
Implement the population health framework for assigned customers to improve overall health and utilization patterns.
Develop and maintain knowledge of current customer contracts and performance guarantees.
Serve as a liaison between all parties to the population health initiative assigned.
Capital Blue Cross promises to go the extra mile for our team and our community. They have been consistently voted one of the “Best Places to Work in PA.”
Conduct new patient and establish-care visits via telemedicine, focusing on chronic condition management.
Collaborate with on-site RNs to develop individualized care plans tailored to patients' chronic disease burdens.
Perform telemedicine priority care visits for common ailments experienced by residents in senior living communities.
Savoy Life is a distributed senior living platform focused on bridging the gap between senior living communities and healthcare. With a team of specialized clinicians, including nurses and geriatricians, Savoy Life offers a tech-enabled solution that empowers senior living operators.
Conduct chart audits for patient encounters, ensuring accurate medical record documentation.
Identify opportunities to improve documentation quality and clinical compliance.
Support the contact center by addressing patient questions and providing education.
Planned Parenthood South Atlantic provides reproductive health care. They are committed to equitable and transparent pay practices and value their employees.
Handle inbound calls from patients and caregivers, providing compassionate and informed triage.
Assist with finding appropriate providers, community resources, and care solutions and coordinate priority virtual appointments.
Research information online and in Privia’s internal knowledge databases to make the most appropriate triage and care advice decisions.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. They optimize physician practices, improve patient experiences, and reward doctors. Their platform is led by top industry talent and consists of scalable operations.
Conduct assessments, establish care goals, and deliver telephonic coaching and education to support clients in managing chronic conditions.
Perform first‑level Utilization Review for inpatient and outpatient services based on plan guidelines.
Document all condition management activities, track client progress, and report outcomes, savings, and quality improvements.
Cottingham & Butler sells a promise to help their clients through life’s toughest moments and aim to hire, train, and grow the best professionals in the industry. Their culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.
Engage with patients and healthcare providers via phone and virtually.
Serve as a clinical resource for therapy adherence, addressing inquiries related to medication and side effects.
Act as a liaison between healthcare professionals and patients, navigating therapy access challenges.
EVERSANA provides commercialization services to the life sciences industry with a global team of more than 7,000 employees. They serve over 650 clients, ranging from innovative biotech start-ups to established pharmaceutical companies, to bring therapies to market and support patients.
Remotely triage after hours calls 5pm to 8:30am during the week and full days on Saturdays and Sundays
Responsible for after hour admissions and triaging clinical concerns after business hours
Problem solve and maintain emergencies by coordinating all clinical issues with the on-call manager
BAYADA Home Health Care is a leading home health care company that believes that our clients and their families deserve home health care delivered with compassion, excellence, and reliability. As a mission-driven nonprofit, BAYADA is celebrating 50 years offering compassion, excellence, and reliability.