The Retention & Eligibility Advisor oversees member retention programs by identifying disenrollment trends and implementing strategies to increase loyalty. They act as a liaison between members and health plan teams while managing disenrollment requests and conducting outreach.
The Vice President of Pharmacy Services provides strategic leadership and oversight for all pharmacy operations, including PBM management, formulary strategy, and financial performance. They ensure regulatory compliance, optimize clinical and fiscal outcomes, and collaborate across the organization to support patient-centered care.
The Utilization Review Nurse ensures high-quality, cost-efficient medical outcomes for enrollees needing inpatient/outpatient authorizations. Responsibilities include reviewing prior authorization requests, coordinating transitions of care, and managing health care within compliance regulations.
