7Seventy Recruiting · 13 hours ago
Clinical Care Coordinator - $23.00 - $26.00 per hour
United States
Full-time
Remote
New Grad, Entry Level
$23/hr - $26/hr7Seventy Recruiting is seeking a detail-oriented Clinical Coordinator to support coverage determinations and appeals. The role involves ensuring requests are processed efficiently and accurately while maintaining compliance with established policies and regulatory requirements.
Information Services
Responsibilities
Create case files and accurately transcribe clinical documentation for coverage determination and appeal requests
Research claim reject messages related to coverage determinations and appeals to support pharmacist review
Contact prescriber offices to obtain additional information required to process requests
Configure approved coverage determination and appeal outcomes in the adjudication system following clinical review and decision
Handle inbound phone calls from prescribers and members regarding coverage determinations
Respond to routine inquiries and correspondence related to coverage determinations and appeals with members, prescribers, and pharmacies
Notify physicians, members, and other applicable healthcare professionals of coverage determination decisions
Ensure requests are processed accurately and within required timelines
Maintain compliance with established protocols and applicable regulatory and accrediting requirements
Perform other job-related duties as assigned
Qualification
Required
Knowledge of the healthcare, insurance, or pharmacy benefit management (PBM) industry
Experience with pharmacy benefit management, coverage determinations, appeals and grievance (CDAG) operational processes, and related regulatory requirements
Strong computer skills with solid typing proficiency
Ability to adapt and perform effectively in a fast-paced, dynamic environment
Highly motivated, well-organized, and able to work independently with minimal supervision
High school diploma or GED required
Current and valid Pharmacy Technician Certification, licensure, or registration is required
Preferred
Bachelor's degree strongly preferred
Benefits
Health
Dental
Vision
Life
401(k)
Paid Time Off (PTO)
Company
7Seventy Recruiting
7Seventy Recruiting connects employers with qualified candidates through transparent, data-driven recruitment solutions.
2-10 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase