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TrueScripts Management Services
TrueScripts Management Services
51 – 200 Darbuotojai
KonsultavimasSveikatos draudimasSveikatos priežiūra
„TrueScripts Management Services“ teikia receptinių vaistų išmokų administravimo paslaugas nariams, klientams, brokeriams ir vaistus skiriantiems specialistams. Sveikatos priežiūros ir sveikatos draudimo srityse veikianti įmonė kuria pritaikytus sprendimus, orientuotus į išlaidų mažinimą, skaidrius procesus ir operatyvią pagalbą. Tarp teikiamų paslaugų yra išankstinių leidimų koordinavimas, o prašymai išnagrinėjami per 24–48 valandas. Daugeliu atvejų su klientų aptarnavimo atstovais galima susisiekti tiesiogiai.
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Prior Authorization Clinical Criteria Policy Coordinator - Washington Remote

Coordinate clinical criteria development and implementation for prior authorization medications at TrueScripts Management Services. Maintain compliant policies, forms, documentation, state-specific requirements, and workflow updates.

USJungtinės ValstijosWAVašingtonas
25 $ / valanda
NuotolinisVisas etatasVidutinis lygisVyresnysis specialistasPrivaloma Kalba: anglųBendraKlinikinis koordinatorius

Aprašymas

  • Draft medication-specific clinical criteria policies and question sets using FDA labeling, clinical guidelines, and drug compendia
  • Conduct initial reviews for clinical accuracy and consistency with applicable guidelines
  • Use dashboards and reports to identify medications requiring new or revised criteria
  • Route criteria to pharmacists and the policy committee for review and approval
  • Prepare policy committee summaries and supporting documentation
  • Maintain the Confluence master tracking log with approvals, effective dates, review dates, and version history
  • Configure approved criteria and question sets in the prior authorization platform
  • Create and run test cases covering question logic, branching, and outcomes
  • Move approved, tested policies into production while preserving version control
  • Create and maintain prior authorization forms and correspondence templates
  • Research state-specific prior authorization rules and incorporate them under Compliance guidance
  • Keep state requirement reference logs organized by state and client or plan
  • Implement compliant member notifications covering approvals, denials, and appeal rights
  • Manage the Confluence criteria repository and archive retired or superseded policies
  • Create and revise job aids for the Prior Authorization Coordinator Team
  • Communicate criteria revisions and workflow changes to internal teams and stakeholders
  • Provide subject matter guidance on applying clinical criteria
  • Support client, URAC, NCQA, and state regulatory audits
  • Review criteria effective dates and confirm alignment with plan parameters
  • Support appeal and grievance reviews with relevant criteria documentation and rationale
  • Coordinate expedited criteria development for urgent needs
  • Complete other assigned duties

Reikalavimai

  • High school diploma required; an associate degree is preferred
  • Pharmacy technician experience is strongly preferred
  • Experience with pharmacy prior authorizations, PBM operations, or clinical criteria drafting is strongly preferred
  • Strong research ability, including interpretation of FDA labeling, clinical guidelines, and drug literature
  • Excellent written communication for policy development, documentation, and collaboration across teams
  • Experience using a prior authorization platform or comparable processing and workflow software is preferred
  • Familiarity with Confluence or a similar knowledge management system
  • Strong organization and attention to detail, with the ability to manage multiple criteria projects concurrently
  • Proficiency with Microsoft Office 365, including Word, Excel, and Outlook
  • Ability to work independently while collaborating with pharmacists, the policy committee, and the Prior Authorization Coordinator Team
  • Proactive, detail-focused approach with strong analytical thinking and problem-solving skills
  • Ability to sit, use hands and fingers, and type for up to eight hours during the workday
  • Ability to understand and follow the Confidentiality and Personal Health Information (PHI) Guidelines in the Employee Handbook

Privalumai

  • Multiple health insurance options, including medical, dental, and vision coverage
  • Company bonus program
  • 401(k) plan with company matching
  • Employee Stock Ownership Plan with annual allocations through a Qualified Retirement plan
  • Wellness program offering financial incentives, chiropractic and massage services, and fitness stipends
  • Collaborative, family-oriented workplace culture
  • Charitable giving support and volunteer time
  • Regular company celebrations

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