Onco360 Pharmacy is looking for a Medical Prior Authorization Specialist for our Pharmacy located in New Hyde Park, NY. Work Hours: Monday-Friday - Daytime Hours either 8:30am- 5pm EST or 9:30am-6pm EST. This role may work remotely. **Starting salary at $25/hr** We also offer quarterly incentive bonuses. We offer a variety of benefits including: - Medical, Dental & Vision insurance - 401k with a match - Paid Time Off and Paid Holidays - Tuition Reimbursement - Paid Volunteer Day - Floating Holiday - Referral Incentive - Paid Life, and short & long-term disability insurance Medical Prior Authorization Specialist Summary: The Medical Prior Authorization Specialist will ensure patients receive medications that requires pre-authorization from insurance carriers by reviewing orders and clinical documentation received and investigate/identify authorization requirements needed to obtain medication coverage. They will ensure accurate insurance benefit documentation is made for specific IV and infused therapy orders. Medical Prior Authorization Specialist Major Responsibilities: - Manage prior authorization requests and appeals with insurance carriers as well as collaborating with physicians, pharmacists, and other departments. - Develop expertise and maintain in-depth knowledge of insurance authorization policies, coverage terms, and complex authorization and appeal process. Identify the appropriate clinical records and submit the authorization request to the insurance company based on plan requirements for approval. - Maintain accurate documentation of authorization details and proactively monitor and renew expiring authorizations. - Facilitate process for requesting medical authorizations, completing appeals for applicable commercial, Medicaid, and Medicare, or facility medication claims. - Will require reimbursement experience for oncology and/or specialty injected/infused products in a buy and bill setting across all sites of care. - Ensure HIPAA compliance while handling sensitive patient information. - Communicate succinctly and professionally both verbally and through written correspondence with Physician offices, nurses, insurance companies and patients as needed. - Exhibits a positive, courteous, respectful, and helpful attitude towards patients, team members, payers, and management. Contributes team effort by accomplishing related tasks as needed and other duties as assigned. - Knowledge of payer landscape including state, federal, private third-party reimbursement issues, methodologies, and policies for physician administered products - Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. Education/Learning Experience - Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification - Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience Work Experience - Required: 1+ years’ Prior Authorization experience - Desired: 3+ years Specialty Pharmacy, Medical, and/or Infusion prior authorization experience Skills/Knowledge - Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills. - Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience Licenses/Certifications - Required: None - Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB) Behavior Competencies - Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion. We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

• Apply clinical skills and expertise in conjunction with established medical criteria • Maintain a thorough and comprehensive understanding of regulations, payer contracts, product lines, NELC policies & procedures • Review clinical documentation for long term government payers twice a year • Act as a liaison between internal and external customers • Determine appropriateness and effectiveness of services requested • Responsible for timely and comprehensive medical review with concise documentation • Effectively communicate coverage decisions to members, providers, and medical groups • Identify and appropriately inform Manager/Supervisor of sensitive or complex cases • Develop and maintain positive working relationships with Medical Directors, physicians, vendors • Maintain confidentiality of member and case information

Role Description Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: - You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. - Hours: 8am - 5pm in your local time zone - Call rotation - 1 weekend every 16 weeks - You will report into the Associate Medical Director, Utilization Management. - Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote - Pay Transparency: The base pay for this role is: $211,200 - $277,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses. Responsibilities: - Provide timely medical reviews that meet Oscar's stringent quality parameters. - Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen. - Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level). - Use correct templates for documenting decisions during case review. - Meet the appropriate turn-around times for clinical reviews. - Receive and review escalated reviews. - Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research. - Compliance with all applicable laws and regulations. - Other duties as assigned. Qualifications - Board certification as an MD or DO. - Licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC. - 6+ years of clinical practice. - 1+ years of utilization review experience in a managed care plan (health care industry). Requirements - Licensure in multiple Oscar states (bonus points). - BC in Cardiology, Radiation/Oncology, or Neurology (bonus points). - Experience with care management within the health insurance industry (bonus points). - Willing and able to obtain additional state licensure as needed, with Oscar's support. Benefits - Medical, dental, and vision benefits. - 11 paid holidays. - Paid sick time. - Paid parental leave. - 401(k) plan participation. - Life and disability insurance. - Paid wellness time and reimbursements.

Role Description Carebridge LPN/LVN at CareBridge Health is responsible for the examination and treatment of patients under the direction of the physician. - Reviews patient medical records, interviews patients, and records vital signs. - Provides nursing interventions and coaching in accordance with the scope of practice and standing orders. - Facilitates patient transfers to alternate level of care as needed. - Documents using standard templates. - Ability to be on the phone engaging with patients up to 80% of the shift. - Ability to work assigned weekends per standard team rotation. - Reliable internet and a high level of customer service. Qualifications - Requires an LPN or LVN and a minimum of 2 years of experience as an LPN/LVN; or any combination of education and experience that would provide an equivalent background. - Current LPN/LVN license in the applicable state required. - Satisfactory completion of a Tuberculosis test is a requirement for this position. Requirements - Bi-lingual (English/Spanish) preferred. - Experience with Telephonic Triage preferred. - Acute care experience (e.g., urgent care or ER) preferred. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).