Facilitate utilization management requests for coverage and enter authorizations into the claims platform. Coordinate with pharmacists and medical directors while managing member and provider communications regarding specialty pharmacy programs.
Rightway
13 Remote Job Openings at Rightway
Define and deploy mission-critical data infrastructure and production-grade pipelines to process large healthcare datasets. Leverage AI tools and AWS services to optimize data transformations and improve platform reliability.
Perform clinical triage and care coordination to help members navigate healthcare resources and manage their care needs. Act as a trusted advisor to improve clinical outcomes and reduce unnecessary healthcare costs through proactive outreach and education.
Design, build, and maintain scalable data models and products using dbt to support pharmacy benefit management and care navigation. Collaborate with cross-functional teams to transform complex healthcare data into trusted datasets for operational reporting and strategic decision-making.
Support the design, maintenance, and optimization of formularies and prior authorization criteria using data-informed recommendations. Integrate AI tools into clinical workflows to streamline operations and accelerate research and policy drafting.
The Benefit Specialist sources and maintains up-to-date healthcare benefit information to support Health Guides and members. They are responsible for conducting quality audits, managing content systems, and explaining financial responsibilities like deductibles to members.
Lead daily accounting operations including payables, billing, payroll, and general ledger reconciliations. Support monthly, quarterly, and year-end close processes while contributing to financial statements and audit preparations.
Lead the Application and Cloud Security functions to raise the security maturity of AWS systems and services. Architect defensive controls for AI/LLM capabilities and establish secure engineering patterns across the organization.
Manage day-to-day operational relationships for PBM clients, including resolving escalations and conducting business reviews. Coordinate with implementation and internal operations teams to ensure seamless onboarding and contractual delivery.
Own and evolve the vision for the digital pharmacy experience, focusing on member engagement and outcomes across web and mobile apps. Lead the development of features like drug search and cost transparency while mentoring an Associate Product Manager.
Lead a team of embedded analysts across PBM functions to deliver actionable insights and scalable data products. Partner with business leaders to align analytics workstreams with operational excellence and client success goals.
The Senior Manager will lead clinical consulting services and drive initiatives to improve pharmacy benefit plan performance. They will act as a subject matter expert, collaborating with internal teams and clients to enhance clinical outcomes and cost efficiency.
The role involves designing, developing, and maintaining scalable data models, primarily using dbt, to power a Financial Risk Engine by integrating claims, contract, pricing, and utilization data within the Unified Data Warehouse (UDW). This engineer will also partner with finance and operations teams to translate complex financial structures into transparent, auditable data models and build curated data marts for self-service analysis.
