PRN Clinical Assistant (47338)

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.