• Answer inbound calls and return voicemails from members, delivering exemplary customer service and support. • Troubleshoot and resolve prescription-related issues for members whose plans utilize CVS or Carelon as the PBM. • Coordinate with providers’ offices and retail/mail-order pharmacies as needed to resolve claims processing, prior authorization, and medication access issues. • Document all actions, progress, and communication in the ticketing system and Acuity, updating ticket status in accordance with internal standards. • Conduct proactive member outreach, including but not limited to disruption list communications and follow-up calls. • Collaborate closely with Pharmacy Services team members and cross-functional departments to ensure timely resolution of pharmacy-related concerns. • Perform other duties as assigned.

• Interpret formulary and clinical program performance data — using available dashboards and reporting tools — to identify trends and opportunities. • Translate data findings into clear, actionable clinical recommendations for clinical strategy leadership. • Support RFI and RFP submissions with data-driven clinical insights. • Actively incorporate AI tools into your daily workflow — from literature review and PA criteria drafting to formulary documentation and data summarization. • Identify opportunities where AI can streamline clinical operations tasks and help the team scale effectively. • Contribute to Rightway's evolving approach to AI adoption in clinical work; share learnings and best practices with the broader team. • Leverage AI-assisted tools to synthesize clinical literature, draft policy language, and accelerate research tasks. • Support the development, maintenance, and updating of Rightway formularies, including standard and custom drug lists. • Assist in formulary coding and collaborate with the claims platform team to ensure accuracy and functionality. • Participate in formulary testing, validation, and ongoing quality review. • Contribute to Pharmacy & Therapeutics (P&T) Committee meetings with drug evaluations, literature summaries, and formulary performance updates. • Help explore and support the implementation of non-traditional formulary designs beyond tier-based structures. • Develop, maintain, and update prior authorization criteria and clinical coverage policies. • Review PA criteria against current clinical evidence, payer benchmarks, and regulatory standards. • Support clinical reviews and provide recommendations on complex or escalated PA cases, as needed. • Assist in communicating PA criteria changes to operational teams, clients, and members. • Partner with Director of Utilization Management on the implementation and operations of clinical strategy. • Partner with Product, Data & Insights, Cost of Goods, and Client Operations teams to support formulary and clinical program implementation. • Provide clinical support to operational teams and clients during implementation and ongoing account management. • Facilitate communication and education to clients, members, and internal staff on clinical topics and formulary changes.

• Coordinate and process medication refills, including data entry and claim adjudication • Place outbound refill calls and assist patients through the refill request • Respond to and resolve inbound patient and provider inquiries • Clarify prescription orders with pharmacists or clinical staff • Maintain and update patient and prescription data in software systems • Spot trends, recommend improvements, and support process-improvement initiatives • Partner with cross-functional teams to deliver a seamless patient experience • Maintain confidentiality and uphold high-quality service standards

• Performs telephonic comprehensive medication reviews • Updates patient profiles based on information gathered during the review • Reviews any Drug Therapy Problems to optimize patient’s drug therapy and minimize the potential for adverse drug reactions • Works with multidisciplinary team to enhance and develop our MedPro software. • Completes at least (2) two CMR’s per hour • Assists Clinical team in meeting proficiency and quality goals • Utilizes client formulary information and member specific benefits to guide appropriate medication recommendations • Maintains current on emerging trends that will educate clinical team, physicians and other prescribers