• Job Description

  Req#: 156064
  General Purpose:
  
  The PRN Clinical Assistant supports preventive care, medication optimization, quality improvement, and population health initiatives through member, provider, pharmacy, and ancillary outreach, documentation retrieval, appointment coordination, and follow-up activities.
  
  Essential Duties & Responsibilities:
  Member Outreach & Care Coordination
  
  • Conduct outbound calls to members/providers identified for care coordination support.
  • Assist members with:
    • Scheduling bone density scans (BDS/DEXA) and other preventive appointments as directed.
    • Providing appointment reminders and follow-up calls to confirm completion.
    • Coordinating with imaging centers to obtain test results and documentation.
    • Identifying and documenting non-clinical barriers to care (e.g., transportation, scheduling conflicts, access issues).
    • Providing information on available benefits or resources to help address identified barriers, within scope of practice.
    • Escalating clinical questions or complex concerns to licensed clinical staff per established protocols.
  • Document member-reported concerns and escalate clinical questions to licensed staff (RN/LPN/Pharmacist) per protocol.
  • Provide standardized, call guide-based education approved by clinical leadership.
  • Medication Optimization Support
    • Support medication-related outreach initiatives including adherence, medication optimization, safety, and preventive quality programs.
    • Conduct outbound calls to provider offices, pharmacies, and ancillary partners regarding medication-related interventions.
    • Assist with obtaining documentation, medication-related records, and provider responses through phone, fax, electronic communication, and other approved channels.
    • Relay standardized, pre-approved clinical messaging and documentation requests.
    • Support workflows related to:
      • Contraindications
      • Missing or suboptimal therapy opportunities
      • Medication not indicated
      • Drug interactions
      • Duplicate therapy
      • High dosage alerts
      • Potential adverse drug reactions
      • Cost-savings opportunities
    • Assist with status updates from provider offices and pharmacies.
    • Track intervention outcomes and document outreach activities in designated systems.
    • Escalate clinical questions or medication-related concerns to licensed clinical staff per protocol.
  Provider & Ancillary Services Coordination
  
  • Contact provider offices to confirm bone density scan (BDS/DEXA) orders, appointment dates.
  • Request and obtain completed imaging reports per established protocols.
  • Follow up on outstanding documentation to ensure timely receipt and closure of care gaps.
  • Coordinate with imaging centers to confirm appointment status and retrieve completed scan results.
  • Relay standardized, pre-approved communications when required.
  • Maintain professional and respectful relationships with external offices and imaging partners.
  Administrative Support
  
  • Accurately document all outreach attempts, scheduling updates, and documentation status in designated systems.
  • Track pending appointments, incomplete scans, and outstanding records to ensure timely follow-up.
  • Meet established productivity and quality benchmarks for outreach and documentation accuracy.
  • Escalate clinical questions or documentation discrepancies to licensed staff per protocol.
  • Support workflow improvements and process optimization initiatives as directed by leadership.
  
  Education & Experience:
  
  • One of the following required:
    • Certified or Registered Medical Assistant (CMA/RMA)
    • Certified Pharmacy Technician (CPht)
    • Pharmacy Intern in good standing with an accredited College of Pharmacy and experience w/ provider outreach
  • Minimum 1 year of experience in a clinical back-office setting preferred.
  • Experience communicating with provider offices, pharmacies, or ancillary healthcare partners preferred.
  • Experience with medication adherence, medication therapy management (MTM), prior authorizations, refill coordination, or quality initiatives preferred.
  • Experience coordinating referrals, imaging, or specialty appointments preferred.
  • Experience requesting and obtaining medical records, imaging reports, or other clinical documentation from provider offices, pharmacies, or ancillary facilities preferred.
  • Experience tracking and obtaining diagnostic test results (e.g., imaging, labs) preferred.
  
  Familiarity with bone density scan (BDS/DEXA) coordination, preventive screenings, or care gap closure initiatives preferred. Experience conducting outbound reminder calls and follow-up outreach preferred.
  
  • Experience working in a metrics-driven, call-based, or population health environment preferred.
  • Experience with Medicare Part D, medication adherence, medication quality measures, or population health programs preferred.
  • Experience reviewing, supporting, or documenting medication-related interventions such as adherence opportunities, medication safety concerns, therapy optimization opportunities, duplicate therapy, drug interactions, or contraindications a plus.
  • Experience supporting provider outreach, pharmacy support workflows, or clinical optimization initiatives strongly preferred
  • Prior experience in care coordination, clinical support, call center operations, pharmacy support, or population health preferred.
  • Experience supporting prior authorization, referral management, or medical records workflows preferred.
  • Experience in provider outreach, care gap closure, medication-related quality initiatives, or clinical quality improvement programs strongly preferred.
  • Proficiency with call center phone systems and outbound dialer technologies, and web-based documentation platforms preferred.
  • Proficient in Microsoft Office applications
  Skills & Competencies
  
  • Familiarity with pharmacy and medical terminology and medication names preferred.
  • Ability to communicate professionally with provider offices and pharmacies regarding medication-related workflows.Ability to follow structured call guides and workflows.
  • Excellent documentation skills and attention to detail.
  • Strong organizational and time-management skills.
  • Comfortable working within standardized clinical protocols and escalation pathways.
  • Ability to manage multiple outreach queues and follow-up tasks simultaneously.
  • Proficient in Microsoft Office and web-based systems.
  
  Minimum Physical Requirement:
  
  The PRN Clinical Assistant will perform his or her work both in a remote, secure home environment and in a general office environment using standard office equipment. The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job:
  
  • Regularly lift and/or move up to 10 pounds
  • Bend, twist or stoop on a repetitive and continuous basis
  • Stand and remain on feet for extended periods of time
  • Operate various business instruments, including computers, printers/scanners/fax machines, requiring manual dexterity
  • Sit and concentrate for long periods of time to compute, examine, and interpret data
  • Read paperwork and computer monitors, requiring visual acuity
  
  Skills:
  
  • Strong interpersonal and communication skills with the ability to build rapport with members, provider offices, and pharmacies.
  • Professional phone etiquette with confidence conducting outbound outreach calls.
  • Ability to follow structured scripts, workflows, and standard operating procedures.
  • Strong organization time-management skills with the ability to manage multiple follow-up tasks.
  • Detail-oriented with accurate and timely documentation skills.
  • Ability to identify non-clinical barriers (transportation, access, scheduling) and escalate clinical concerns appropriately.
  • Comfortable working in a fast-paced, metrics-driven environment.
  • Ability to adapt to process updates and workflow changes.
  • Basic understanding of medical terminology.
  • Proficiency in Microsoft Office and web-based documentation systems.
  • Demonstrates sound judgment within scope of defined role and supervision structure.

• About the company

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