CenterWell Senior Primary Care

Physician Assistant

• Report to the Center Administrator
• Work onsite at an outpatient clinic
• Discuss patient symptoms and obtain vital signs
• Administer medications and vaccines
• Perform phlebotomy and collect specimens
• Sterilize and clean equipment
• Maintain examination rooms
• Document information in the electronic medical records system

Medical Assistant

Pharmacist

• Act as the intake for calls from patients, pharmacies, and providers
• Lead advanced and highly specialized administrative, operational, and customer support duties
• Support the Integrated Clinical Pharmacist with medication reconciliation
• Prepare for medication therapy management activities
• Support chronic disease management
• Review medication brand and generic names, medical terminology, and pharmaceutical calculations
• Conduct medication adherence outreach, auditing, documentation, and reporting for STAR measures
• Interact with other departments to resolve member problems and questions related to prior authorization or obtaining medications
• Attend team meetings and provide workflow feedback
• Troubleshoot prescription third-party claim rejections by reviewing formulary restrictions, plan limitations, drug utilization review overrides, and prior authorizations
• Initiate and follow through with patient assistance programs, prior authorizations, formulary exceptions/alternatives, and tier reductions
• Assist with disease management scheduling, pre-appointment preparation, and follow-up medication education tasks
• Assist with medication therapy management scheduling, pre-appointment preparation, and medication reconciliation/education follow-up
• Process select medication claim updates as requested by clinical pharmacists or providers

Consultative Pharmacy Technician

• Act as intake for calls from patients, pharmacies, and providers
• Perform advanced administrative, operational, and customer support duties
• Support the interdisciplinary CIT team in resolving medication access barriers
• Conduct medication list reviews
• Address formulary and cost-management needs
• Assist with Patient Assistance Program applications
• Support Low Income Subsidy screening and enrollment
• Provide Medicare Prescription Payment Plan education
• Resolve pharmacy-related access issues
• Manage referrals through established workflows
• Conduct patient outreach
• Coordinate with clinics and providers
• Document case activity and outreach outcomes
• Review medication brand and generic names, medical terminology, and pharmaceutical calculations
• Perform medication adherence outreach, auditing, documentation, and reporting for STAR measures
• Facilitate resolution of prior authorization and medication access issues
• Attend team meetings and provide workflow feedback
• Receive and manage Internal Medication Access Program referrals
• Initiate and follow through with patient assistance programs, prior authorizations, formulary exceptions/alternatives, and tier reductions
• Provide assistance with medication packaging education, pharmacy transfers, third-party rejections, and override assistance
• Process select medication claim updates as requested by clinical pharmacists or providers
• Follow program guidelines to support timely and appropriate medication access assistance

General

• Strategically identify, develop, and implement programs influencing providers, members, or market leadership toward value-based relationships and improved quality metrics
• Develop programs designed to drive value-based relationships
• Partner with leaders on implementation planning
• Review and communicate program results
• Advise executives on functional strategies, often segment-specific, regarding significant matters
• Exercise independent judgment and decision-making on complex issues
• Analyze variable factors and determine the best course of action
• Work under minimal supervision

Cardiology Program Delivery Lead

Manager

• Ensure optimal continuity of care for patients transitioning into and out of services
• Serve as a CenterWell Home Health representative for discharged patients and patients needing post-acute services
• Navigate healthcare options, post-acute care services, Medicare coverage, billing issues, and healthcare resources
• Provide patient options and education regarding sites of service, specialty offerings, post-acute care, and related questions
• Handle customer issues including location lookup, directions, and complaints
• Determine clinical level of care using discussions, medical records, and other clinical data
• Match patient needs to service locations or provide alternative services
• Advocate for customers throughout the referral process
• Follow up and track referral and admission outcomes
• Support department performance objectives and patient satisfaction goals
• Assist with admissions by serving as a patient ambassador
• Provide education regarding Home Health, Hospice, and Palliative Care Services
• Help with clinical eligibility review for alternate services
• Participate in mandatory HIPAA, Business Ethics and Compliance, and company policy training
• Participate in special projects and perform other assigned responsibilities
• Report directly to the Manager, Care Management

Care Manager, Telephonic Nurse

Representative

• Manage member and provider denials and concerns
• Conduct comprehensive analytic reviews of clinical documentation
• Determine whether a grievance, appeal, or further request is warranted
• Deliver final determinations through collaboration with clinical and other Humana parties
• Perform advanced administrative and customer support tasks independently
• Assist members and provider offices by phone
• Investigate and resolve member and practitioner issues involving Medicare Part B Pharmacy, dual eligible Medicare/Medicaid, diabetic supply, and related claims
• Follow company and department production goals and quality assurance metrics
• Make decisions regarding methods and processes for administrative tasks and projects
• Prioritize requests and interpret or adapt procedures, processes, and techniques

Grievances and Appeals Representative

Telesales

• Conduct outbound calls to members to promote and schedule virtual appointments
• Communicate the benefits of virtual appointments and how they enhance members' healthcare experience
• Use persuasive techniques to encourage members to schedule appointments
• Address questions and concerns about virtual services, providing accurate information and support
• Maintain detailed call records, member responses, and scheduled appointments in the CRM system
• Follow up with members, outside entities, and providers
• Complete member and provider inquiries efficiently to achieve service and quality goals
• Collaborate with team members and supervisors to achieve weekly and monthly scheduling targets
• Stay informed about healthcare services and offerings
• Follow compliance and regulatory requirements when handling member information

Medical Assistant

Consultative Pharmacy Technician

Consultative Pharmacy Technician

Cardiology Program Delivery Lead

Care Manager, Telephonic Nurse

Grievances and Appeals Representative

Outbound Telesales Agent