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TrueScripts Management Services
TrueScripts Management Services
51 – 200 Xodimlar
KonsaltingSog‘liqni saqlashTibbiy sug‘urta
TrueScripts Management Services aʼzolar, mijozlar, brokerlar va retsept yozuvchi tibbiyot xodimlari uchun retsept bo‘yicha dori-darmon imtiyozlarini boshqarish xizmatlarini taqdim etadi. Sog‘liqni saqlash va tibbiy sug‘urta sohalarida faoliyat yurituvchi kompaniya xarajatlarni tejash, shaffof jarayonlar va tezkor qo‘llab-quvvatlashga yo‘naltirilgan moslashtirilgan yechimlarni ishlab chiqadi. Uning xizmatlari qatoriga so‘rovlar 24–48 soat ichida ko‘rib chiqiladigan oldindan ruxsat berishni muvofiqlashtirish hamda aksariyat murojaatlar uchun mijozlarga xizmat ko‘rsatish vakillariga bevosita kirish kiradi.
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Kompaniyadagi ish o‘rinlari

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.

USAmerika Qo‘shma ShtatlariWAVashington
25 $ / soat
MasofaviyTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaKlinik koordinatorUmumiy

Tavsif

  • 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

Talablar

  • 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

Imtiyozlar

  • 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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