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About the Role
The Care Coordinator plays a critical role in ensuring that patients receive timely and appropriate access to pain management medications through effective authorization processes. This position involves thorough review and evaluation of medication requests to verify clinical appropriateness, adherence to regulatory guidelines, and alignment with insurance policies. The specialist collaborates closely with healthcare providers, pharmacists, and insurance representatives to facilitate approvals and resolve any issues related to medication coverage. By managing authorization workflows efficiently, this role helps optimize patient care outcomes while maintaining compliance with legal and organizational standards. Ultimately, the specialist contributes to a streamlined medication authorization process that supports both patient well-being and operational excellence.
Responsibilities
- Review and assess prior authorization requests for pain management medications to ensure clinical necessity and compliance with insurance criteria.
- Communicate with healthcare providers to obtain additional information or clarify prescription details as needed for authorization decisions.
- Coordinate with insurance companies and pharmacy benefit managers to facilitate timely approvals and resolve authorization denials or delays.
- Maintain accurate documentation of all authorization activities and decisions in compliance with organizational policies and regulatory requirements.
- Stay current with evolving pain management guidelines, medication formularies, and insurance policies to inform authorization practices.
Requirements
- High school diploma or equivalent; associate degree or higher in a healthcare-related field preferred.
- Experience in healthcare authorization, pharmacy benefit management, CoverMyMeds or medical billing/insurance processes.
- Strong knowledge of pain management medications and related clinical guidelines.
- Proficiency in using electronic health records (EHR) and prior authorization software systems.
- Excellent communication skills to interact effectively with healthcare providers and insurance representatives.
Skills
- Strong analytical skills to evaluate medication requests against clinical guidelines.
- Effective communication skills for liaising with healthcare providers and insurance personnel.
- Proficiency with electronic health records and authorization software.
- Attention to detail to maintain compliance with regulatory standards and organizational protocols.
Location
- Smithtown, NY
Work Type
- Full-time
- On-site
Education Level
- High school diploma or equivalent
- Associate degree or higher in a healthcare-related field preferred
Salary/Compensations
- $500 Sign-On Bonus
About the Company
- Groth Pain & Spine is seeking a talented, efficient and knowledgeable Care Coordinator to join our incredible, expanding team!
Equal Opportunity
- Groth Pain & Spine is an equal opportunity employer.