Clinical Assistant

This is a fully remote position, open to applicants in United States.

📋 Description

• Prepare, review, and accurately submit clinical prior authorization requests to pharmacy benefit managers (PBMs) and health plans for anti-obesity medications.

• Independently manage intricate exception processes and formulary overrides.

• Investigate, troubleshoot, and resolve complex inquiries related to coverage and prescribing escalations.

• Act as a liaison between the Clinical Assistant team and PBM formulary information.

• Support the training of team members on complex prior authorization guidelines.

• Review and respond to chat messages from medical providers.

• Direct messages to the appropriate parties.

• Ensure timely resolution of issues while adhering to ticket-handling and message-review KPIs.

• Oversee daily workload priorities, monitor queues, and uphold team service level agreements (SLAs).

• Collaborate with multidisciplinary care teams on prescribing plans and medication access for members.

• Maintain confidentiality and comply with HIPAA regulations regarding protected health information (PHI).

• Utilize Zendesk ticketing workflows, internal tools, and communication templates effectively.

• Accurately log hours worked using designated ADP pay codes.

• Adhere to quality assurance, compliance, and clinical protocol guidelines.

• Perform other assigned clinical support and operational tasks.

⛳️ Requirements

• A minimum of 3 years of experience specializing in prior authorizations or PBM navigation within a medical clinic, specialty pharmacy, health plan, or telehealth setting.

• Demonstrated initiative in leading projects or improving workflows, along with mentoring or guiding peers without formal management responsibilities.

• Extensive knowledge of prior authorization submission standards, PBM formulary exception processes, prescribing protocols, and clinical documentation for cardiometabolic and specialty medications.

• Exceptional written and verbal communication skills with a proven capability to diplomatically resolve escalations across departments.

• Proficient in electronic health record (EHR) systems, prior authorization platforms (e.g., CoverMyMeds), and cloud collaboration tools (Google Suite, Slack).

• Strong organizational, time-management, and analytical skills, with the ability to work independently in a high-paced environment.

• Availability to work Monday through Friday between 8:00 AM and 8:00 PM in the candidate’s local time zone.

• Certified Medical Assistant (CMA) or a related healthcare certification is preferred.

• Prior experience in a virtual care, digital health, or rapidly growing startup environment is preferred.

• Familiarity with telehealth technology is preferred.

• Ability to multitask and prioritize within a fast-paced setting is preferred.

• Compassionate and patient-focused approach to care is preferred.

• Strong organizational skills and attention to detail are preferred.

🏝️ Benefits

• Potential for extension beyond the 3-month seasonal position based on performance and business requirements.

• Equal Employment Opportunity and Affirmative Action employer.

• Reasonable accommodations available for qualified individuals with disabilities and disabled veterans.