About this role
General Purpose:
The PRN Clinical Assistant supports preventive care, medication optimization, quality improvement, and population health initiatives through member, provider, pharmacy, and ancillary outreach, documentation retrieval, appointment coordination, and follow-up activities.
Essential Duties & Responsibilities:
Member Outreach & Care Coordination
- Conduct outbound calls to members/providers identified for care coordination support.
- Assist members with:
Scheduling bone density scans (BDS/DEXA) and other preventive appointments as directed.
- Providing appointment reminders and follow-up calls to confirm completion.
- Coordinating with imaging centers to obtain test results and documentation.
- Identifying and documenting non-clinical barriers to care (e.g., transportation, scheduling conflicts, access issues).
- Providing information on available benefits or resources to help address identified barriers, within scope of practice.
- Escalating clinical questions or complex concerns to licensed clinical staff per established protocols.
- Document member-reported concerns and escalate clinical questions to licensed staff (RN/LPN/Pharmacist) per protocol.
- Provide standardized, call guide-based education approved by clinical leadership.
- Medication Optimization Support
Support medication-related outreach initiatives including adherence, medication optimization, safety, and preventive quality programs.
- Conduct outbound calls to provider offices, pharmacies, and ancillary partners regarding medication-related interventions.
- Assist with obtaining documentation, medication-related records, and provider responses through phone, fax, electronic communication, and other approved channels.
- Relay standardized, pre-approved clinical messaging and documentation requests.
- Support workflows related to:
Contraindications
- Missing or suboptimal therapy opportunities
- Medication not indicated
- Drug interactions
- Duplicate therapy
- High dosage alerts
- Potential adverse drug reactions
- Cost-savings opportunities
- Assist with status updates from provider offices and pharmacies.
- Track intervention outcomes and document outreach activities in designated systems.
- Escalate clinical questions or medication-related concerns to licensed clinical staff per protocol.
Provider & Ancillary Services Coordination
- Contact provider offices to confirm bone density scan (BDS/DEXA) orders, appointment dates.
- Request and obtain completed imaging reports per established protocols.
- Follow up on outstanding documentation to ensure timely receipt and closure of care gaps.
- Coordinate with imaging centers to confirm appointment status and retrieve completed scan results.
- Relay standardized, pre-approved communications when required.
- Maintain professional and respectful relationships with external offices and imaging partners.
Administrative Support
- Accurately document all outreach attempts, scheduling updates, and documentation status in designated systems.
- Track pending appointments, incomplete scans, and outstanding records to ensure timely follow-up.
- Meet established productivity and quality benchmarks for outreach and documentation accuracy.
- Escalate clinical questions or documentation discrepancies to licensed staff per protocol.
- Support workflow improvements and process optimization initiatives as directed by leadership.
Education & Experience:
- One of the following required:
Certified or Registered Medical Assistant (CMA/RMA)
- Certified Pharmacy Technician (CPht)
- Pharmacy Intern in good standing with an accredited College of Pharmacy and experience w/ provider outreach
- Minimum 1 year of experience in a clinical back-office setting preferred.
- Experience communicating with provider offices, pharmacies, or ancillary healthcare partners preferred.
- Experience with medication adherence, medication therapy management (MTM), prior authorizations, refill coordination, or quality initiatives preferred.
- Experience coordinating referrals, imaging, or specialty appointments preferred.
- Experience requesting and obtaining medical records, imaging reports, or other clinical documentation from provider offices, pharmacies, or ancillary facilities preferred.
- Experience tracking and obtaining diagnostic test results (e.g., imaging, labs) preferred.
Familiarity with bone density scan (BDS/DEXA) coordination, preventive screenings, or care gap closure initiatives preferred. Experience conducting outbound reminder calls and follow-up outreach preferred.
- Experience working in a metrics-driven, call-based, or population health environment preferred.
- Experience with Medicare Part D, medication adherence, medication quality measures, or population health programs preferred.
- Experience reviewing, supporting, or documenting medication-related interventions such as adherence opportunities, medication safety concerns, therapy optimization opportunities, duplicate therapy, drug interactions, or contraindications a plus.
- Experience supporting provider outreach, pharmacy support workflows, or clinical optimization initiatives strongly preferred
- Prior experience in care coordination, clinical support, call center operations, pharmacy support, or population health preferred.
- Experience supporting prior authorization, referral management, or medical records workflows preferred.
- Experience in provider outreach, care gap closure, medication-related quality initiatives, or clinical quality improvement programs strongly preferred.
- Proficiency with call center phone systems and outbound dialer technologies, and web-based documentation platforms preferred.
- Proficient in Microsoft Office applications
Sk ills & Competencies
- Familiarity with pharmacy and medical terminology and medication names preferred.
- Ability to communicate professionally with provider offices and pharmacies regarding medication-related workflows. Ability to follow structured call guides and workflows.
- Excellent documentation skills and attention to detail.
- Strong organizational and time-management skills.
- Comfortable working within standardized clinical protocols and escalation pathways.
- Ability to manage multiple outreach queues and follow-up tasks simultaneously.
- Proficient in Microsoft Office and web-based systems.
Minimum Physical Requirement:
The PRN Clinical Assistant will perform his or her work both in a remote, secure home environment and in a general office environment using standard office equipment. The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job:
- Regularly lift and/or move up to 10 pounds
- Bend, twist or stoop on a repetitive and continuous basis
- Stand and remain on feet for extended periods of time
- Operate various business instruments, including computers, printers/scanners/fax machines, requiring manual dexterity
- Sit and concentrate for long periods of time to compute, examine, and interpret data
- Read paperwork and computer monitors, requiring visual acuity
Skills:
- Strong interpersonal and communication skills with the ability to build rapport with members, provider offices, and pharmacies.
- Professional phone etiquette with confidence conducting outbound outreach calls.
- Ability to follow structured scripts, workflows, and standard operating procedures.
- Strong organization time-management skills with the ability to manage multiple follow-up tasks.
- Detail-oriented with accurate and timely documentation skills.
- Ability to identify non-clinical barriers (transportation, access, scheduling) and escalate clinical concerns appropriately.
- Comfortable working in a fast-paced, metrics-driven environment.
- Ability to adapt to process updates and workflow changes.
- Basic understanding of medical terminology.
- Proficiency in Microsoft Office and web-based documentation systems.
- Demonstrates sound judgment within scope of defined role and supervision structure.