The Risk Performance Analyst supports enterprise goals by identifying and addressing financial, clinical, and client retention risks across departments. They are responsible for tracking interdepartmental risks, engaging stakeholders, and providing performance reports to leadership.
The pharmacist is responsible for conducting clinical prior authorization reviews and appeal determinations while collaborating with providers to ensure appropriate pharmacy care. They also monitor clinical interventions to meet savings goals and provide clinical expertise to internal teams and members.
The Care & Resolution Specialist serves as the primary point of contact for complex member inquiries, ensuring prompt and compassionate resolution of escalated concerns. They act as an administrative liaison between members, pharmacies, and prescribers while managing prescription claims and benefit authorizations.
