TrueScripts Management Services

Application Engineer

• Design, develop, test, deploy, and support secure enterprise web applications using Microsoft .NET technologies
• Build and maintain internal and external-facing APIs supporting business processes, integrations, and application functionality
• Develop solutions using C#, .NET, ASP.NET, Blazor, JavaScript, HTML, CSS, and modern front-end frameworks
• Design or assist with Microsoft SQL Server tables, views, stored procedures, and queries
• Collaborate with business users, product owners, analysts, and developers to gather requirements and translate business needs into technical solutions
• Build cloud-native applications using Microsoft Azure services such as Functions and Logic Apps
• Participate in architecture decisions concerning performance, scalability, maintainability, and security
• Support authentication, authorization, and identity management using OpenID Connect, OAuth, Azure AD, or Azure B2C
• Develop and maintain integrations with internal systems, external platforms, and third-party services
• Troubleshoot, debug, and resolve application issues across development, test, and production environments
• Write clean, maintainable, well-documented code aligned with team standards and secure development practices
• Participate in code reviews, quality assurance, and continuous improvement of development processes
• Use source control, DevOps pipelines, and deployment tools for reliable software delivery
• Modernize legacy applications, improve system performance, and reduce technical debt
• Protect sensitive business, client, member, and healthcare-related information
• Stay current with modern application development practices, Microsoft cloud technologies, and emerging software delivery tools

Clinical Coordinator

• Draft clinical criteria policies and question sets for medications requiring prior authorization using FDA labeling, clinical guidelines, and drug compendia
• Perform initial quality checks for clinical accuracy and guideline alignment
• Identify medications needing new or updated criteria using dashboards and reporting
• Submit criteria for pharmacist and policy committee review and approval
• Prepare summary materials and supporting documentation for policy committee review
• Maintain the master criteria tracking log in Confluence, including approvals, effective dates, review dates, and version history
• Build approved criteria and question sets in the prior authorization platform
• Develop and execute test cases for question logic, branching, and outcomes
• Migrate approved and tested policies to production and maintain version control
• Build and maintain prior authorization forms and correspondence templates
• Research and incorporate state-specific prior authorization requirements under Compliance guidance
• Maintain reference logs of state-specific requirements by state and client/plan
• Implement compliant member notifications for approvals, denials, and appeal rights
• Steward the Confluence criteria repository and archive retired or superseded criteria
• Create and update job aids for the Prior Authorization Coordinator Team
• Communicate criteria updates and workflow changes to internal teams and stakeholders
• Serve as a subject matter resource on criteria application
• Support client, URAC/NCQA, and state regulatory audits
• Audit criteria effective dates and alignment with plan parameters
• Assist with appeals or grievance reviews by providing criteria documentation and rationale
• Manage expedited criteria development for urgent situations
• Perform other duties as assigned

Prior Authorization Clinical Criteria – Policy Coordinator

Customer Success Manager

• Lead the strategic account team, including client success, clinical, and data analytics, with ownership of client satisfaction and service delivery
• Serve as the client contact by telephone and email to resolve ongoing questions and issues
• Oversee execution of the communication plan
• Develop strong internal and client relationships through proactive interactions
• Collaborate with account management, clinical, member care, business analyst, data analytics, and business development teams
• Analyze claims data with the POD to identify drug trends, financial performance, and client cost-saving opportunities
• Maintain expert knowledge of TrueScripts proprietary programs
• Execute client renewals by building lasting relationships with key client stakeholders
• Coordinate all aspects of client review meetings, including scheduling, reporting, materials, and accommodations
• Use CRM and proprietary claims adjudication software
• Lead client meetings and lunch-and-learn meetings
• Adjust plan parameters with the POD as directed by the client or broker
• Oversee onboarding with the client, broker, TPA, and data vendor
• Participate in introductory and employee enrollment meetings

Client Success Executive – Prescription Benefits

Manager

• Lead and manage TrueScripts’ comprehensive audit program
• Establish an annual audit calendar covering regulatory, client, vendor, internal, and other required audits
• Coordinate audits from initiation through final resolution
• Develop audit plans, timelines, evidence requests, testing approaches, and deliverables
• Maintain centralized documentation of audit requirements, evidence, findings, responses, and remediation activities
• Monitor audit deadlines and identify risks to successful completion
• Establish consistent audit processes, standards, templates, and controls
• Coordinate regulatory and healthcare-related audits, including Market Conduct Audits and applicable state and federal examinations
• Partner with Compliance and Legal to interpret audit requirements and prepare organizational responses
• Coordinate client audits and information requests and review responses for completeness and consistency
• Conduct internal audits, process reviews, and control assessments based on risk and regulatory requirements
• Track audit findings and corrective action plans, establish root causes and target dates, monitor remediation, and escalate overdue or high-risk items
• Support claims and PBM audits involving claims configuration, adjudication, pricing, eligibility, benefits, reporting, prior authorization, and pharmacy networks
• Develop audit readiness checklists and documentation standards
• Improve and automate evidence collection, testing, reporting, audit tracking, and workflows
• Lead and develop audit team members as the function grows
• Build relationships with business leaders and serve as a trusted audit advisor
• Promote accountability, transparency, continuous improvement, and risk awareness

Audit Manager

General Counsel

• Serve as the company’s principal legal advisor to the President/CEO and Executive Committee
• Provide practical legal guidance on strategic initiatives, business decisions, growth opportunities, regulatory risk, and enterprise-level issues
• Advise on federal and state laws and regulations affecting PBM operations and healthcare services
• Provide counsel on claims administration, formularies, pharmacy networks, reimbursement, rebates, benefit programs, employer-sponsored health plans, and PBM services
• Advise on state PBM laws, CMS requirements, Medicare and Medicaid matters, ERISA, HIPAA, HITECH, privacy, data security, fraud and abuse, and other healthcare regulations
• Monitor legislative, regulatory, and enforcement developments and provide actionable recommendations
• Draft, review, negotiate, and oversee commercial agreements, including PBM services, client, payor, pharmacy network, manufacturer rebate, vendor, technology, data-sharing, BAA, confidentiality, and other strategic agreements
• Establish contract standards, templates, playbooks, and approval processes
• Provide counsel on corporate governance, board matters, policies, procedures, ESOP matters, and enterprise risk
• Manage litigation, disputes, regulatory inquiries, audits, investigations, and other legal matters
• Coordinate and oversee outside counsel, including strategies, budgets, expectations, and spending
• Build scalable legal processes, templates, workflows, policies, and procedures
• Educate leaders and team members on legal, regulatory, compliance, privacy, and risk considerations
• Build trusted relationships with executive leaders and business partners and support proactive risk management

Application Engineer

Prior Authorization Clinical Criteria – Policy Coordinator

Client Success Executive – Prescription Benefits

Audit Manager

Senior General Counsel