The Clinical Associate supports pharmacy benefit operations by coordinating clinical workflows, processing prior authorizations, and managing appeals. They also provide support to members, providers, and pharmacy staff regarding claim resolution, coverage determinations, and formulary inquiries.
The Member Benefits Advocate manages inbound communications from health plan members and providers to resolve inquiries regarding benefits, eligibility, and claims. They also perform outbound calls to TPA partners and providers to ensure timely resolution of billing and access issues.
The Prior Authorization Pharmacist evaluates pharmacy prior authorization requests to ensure appropriate medication use based on clinical criteria and benefit plans. They also provide clinical leadership, support utilization management initiatives, and collaborate with healthcare providers to optimize therapeutic outcomes.
The Account Executive serves as the primary point of contact for clients, collaborating with internal teams to ensure satisfaction and program performance. They are responsible for analyzing client data, facilitating strategic meetings, and identifying opportunities to improve healthcare cost outcomes.
