HealthCare Partners, MSO - Open Positions

Administration

Executive Administrative Assistant

Reporting to the Chief Physician Officer, the Executive Administrative Assistant (EAA) will provide full administrative support to the Executive Leadership Team supporting day-to-day operations relating to high-impact and valued projects. The EAA will be flexible, proactive, resourceful, and efficient, with a high level of professionalism and confidentiality.

Clinical Services

Clinical Pharmacist

The Clinical Pharmacist at a healthcare-managed services organization plays a crucial role in ensuring optimal medication management and improving patient outcomes. This position involves reviewing prior authorization requests, evaluating pharmacy utilization, performing medication reconciliation, assisting members with medication adherence, and managing medications for chronic conditions. The Clinical Pharmacist will also assess medications for high-risk members enrolled in case management and for members with recurrent hospital admissions. This role will also assess the appropriateness of sites of service for medication administration, serve as a clinical pharmacy resource for other departments, and contribute to achieving high performance on quality pharmacy measures. Additionally, the Clinical Pharmacist will explore opportunities for improved pharmacy utilization, promote the use of biosimilars when appropriate, review specialty medications, and identify cost-containment strategies. Finally, this role will educate and train pharmacy technicians, providers, and members regarding medication management.

Nurse Case Manager, RN (Case Management)

The Nurse Case Manager is responsible for engaging members enrolled in case management to provide comprehensive care coordination and education aimed at improving health outcomes. This role involves assessing medical needs, developing individualized care plans, and collaborating with healthcare professionals to address barriers and ensure continuity of care. The Nurse Case Manager also monitors progress, adjusts care plans as necessary, and supports members in navigating the healthcare system to achieve optimal wellness.

Coding

Medical Coding Analyst

The Coding Analyst will provide Risk Adjustment/HCC coding and auditing services that include the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated alphanumerical codes. The Medical Coder will summarize audit results and provide feedback and education to the field team and providers regarding documentation needs and requirements.

Quality

Clinical Quality Pharmacist

The Clinical Quality Pharmacist supports the MSO by optimizing medication use, improving quality performance, and enhancing patient outcomes across Medicare, Medicaid, and Commercial lines of business. This role focuses on quality measure performance, medication adherence, gaps in care, and provider education.

The pharmacist serves as a clinical subject matter expert, collaborating with providers, care management, pharmacy technicians, and internal teams to close quality gaps, ensure appropriate medication use, and support improved gap closure through both operational and clinical initiatives. Responsibilities include medication reconciliation, adherence interventions, and provider-facing education related to HEDIS, Medicare Stars, QARR, and other quality programs.

Others

Nurse Case Manager, Prior Authorization RN

The Nurse Case Manager, Prior Authorization RN is responsible for reviewing and processing prior authorization requests for medical services, ensuring that all clinical criteria and health plan requirements are met. This role reports to the Manager of Inpatient Utilization Management and involves collaborating with healthcare providers, patients, and internal teams to determine the medical necessity of requested services, ensuring compliance with insurance guidelines, and maintaining accurate documentation. The Nurse Case Manager, Prior Authorization RN will support the goal of delivering timely and efficient authorization decisions while promoting quality patient care.