Clinical - Exception Template

Location: Remote, not state specific but EST time zone is preferred to start. SHIFT: Monday to Friday. Between 8 AM & 6 PM EST Saturday: 1 2 days on rotation basis -might be involved as the program evolves. Subject to change and have flexibility. Duration: 12 months, possible conversion Position Purpose: The purpose of this team is to assist with coordination of healthcare personnel administered drug services at preferred sites of care. Goal is to provide seamless member & provider services. Walk me through the day-to-day responsibilities and a description of the project : Staff will log into phone queue, answer calls from providers, retrieve voicemails, and review reports for any provider & member follow-up calls that need to be conducted. Team members will review prior authorizations to confirm the site of care is appropriate and redirect members to alternative servicing providers when needed based on policy. This will require phone outreach to providers and members. Performance expectations will be based on the quality of customer services to members & providers, site of care review process, and number of successful contacts. Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider physician injectable claims issues. Perform training, orientation and coaching for performance improvement within physician practices. Communicate effectively and partner with all internal departments to ensure members and providers have a positive, successful outcome. Education/Experience: Bachelor s degree in Healthcare related field preferred. 3 years of combined public relations and pharmacy related experience. Knowledge of health care, managed care, Medicare or Medicaid preferred. Claims billing/coding knowledge preferred. License/Certification: Valid driver s license. CPhT license preferred. Candidate Requirements Education/Certification Required: High School Diploma or equivalent Preferred: Bachelor s degree in healthcare related field. Licensure Required: N/A Preferred: Current state s Certified Pharmacy Technician (CPhT) license Years of experience required: 3 years of experience in healthcare Disqualifiers: Additional qualities to look for: Knowledge of health care, managed care, Medicare or Medicaid preferred. Claims billing/coding knowledge preferred. Customer service experience

Location: New York, US

Posted Date: 6/6/2025