ArchWell Health

Process refill requests, conduct patient outreaches, and collaborate with healthcare teams to optimize medication use. | Registered Pharmacy Technician with 2+ years experience, strong customer service, and proficiency in Microsoft Office. | ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities. Job Summary: The Pharmacy Technician is an important colleague of ArchWell Health Pharmacy Team. Reporting to the Clinical Pharmacist, the Pharmacy Technician will be providing direct patient care and collaborating with other healthcare team members in a virtual environment to optimize the pharmaceutical care for our patients. This individual will conduct patient outreaches per existing protocols and assist patients with navigating the medication use aspects, including reviewing components of their plan benefits. An ideal candidate will have a deep understanding of Medicare Advantage prescription benefits, possess strong attention to detail, and be driven by a passion for providing quality care to seniors. Duties/Responsibilities: • Review and process pharmacy refill requests, either via faxes, EMR routes, or direct incoming calls, per established protocol while meeting the expected turnaround time • Conduct telephonic outreaches and answer incoming calls regarding patient’s medication use, including but not limited to medication adherence, and assist with refilling and following-through in a prompt and respectful manner • Access medication adherence gap portals or lists and review member’s medical chart notes to determine appropriate action • Collaborate with other pharmacy staff, providers, and their care teams as needed to resolve any issues or discrepancies related to medication use • Ensure that all tasks are completed timely, documented accurately, and in accordance with regulations (including HIPAA) and organizational standards • Attend staff meetings and provide input into current trends, process evaluation, and quality improvement • Assist with other pharmacy departmental initiatives as they become available • Additional duties, as assigned Required Skills/Abilities: • Excellent customer service, including telephone etiquette skills, active listening skills, and the ability to follow-through with patients or staff members • Ability to work effectively and respectfully with various seniorities and diverse populations including members, staff, providers, and family members • High degree of emotional intelligence and integrity, resilient and focused work ethic, with adaptability to handle frequent changes with a positive attitude • Self-starter with the ability to think creatively and work effectively • Strong attention to detail and possessing good alpha/numeric data entry skills with minimal errors • Intermediate proficiency in Microsoft Office Suite products including Word, Outlook and Excel plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software • Ability to travel on occasion for company meetings Education and Experience: • High school diploma or equivalent education (GED) required • Registered Pharmacy Technician with a state board of pharmacy • A minimum of 2 years of experience in operational pharmacy benefits (health plan or PBM), clinic setting, high volume call center, or retail pharmacy • eClinicalWorks or similar EMR experience • Experience working with geriatric patients or a medication adherence program is a plus • Bilingual in English/Spanish highly desired ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

Oversee clinical risk management programs including incident reporting, investigations, regulatory compliance, risk assessments, and policy implementation to ensure safety and compliance in healthcare operations. | Bachelor’s degree in nursing, juris doctorate, or related field; 5+ years healthcare risk management experience; preferred Master’s degree and risk management certification; strong healthcare regulations knowledge and analytical skills. | Program Manager, Risk ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities. The Program Manager, Risk will play a critical role in ensuring the safety, compliance, and risk management of our health care operations. Reporting directly to the Director of Risk Management, this person will be responsible for overseeing the incident reporting process, managing the grievance process, and leading the approval and implementation of new policies to enhance our risk management strategies, Duties/Responsibilities: Coordinates the Clinical Risk Management Program to meet the needs of the organization Manages the incident reporting process and reviews and analyzes all occurrences for risk management, quality of care, regulatory and insurance concerns Conducts root cause analysis investigations, focused investigations, and other reviews and investigations. Manage professional and general liability carrier reporting and follow-up. Assist providers with managing licensing board letters of inquiry and investigations. Create quarterly reports reviewing incidents for trends and process improvement. Collaborate with relevant departments to analyze incident data, identify trends, and develop strategies to prevent recurrence. Work closely with compliance regarding regulatory matters. Conduct regular risk assessments across various aspects of the organization, including clinical practices. Collaborate with departments to identify potential risks and develop mitigation plans. Stay up to date with industry regulations and standards related to healthcare risk management. Provide training and educational programs to colleagues on risk management, incident reporting and grievance resolution. Promote a culture of safety and risk awareness throughout the organization. Maintain detailed records of incidents, health plan grievances, and risk assessment. Create update and maintain risk management policies and procedures that outline the organization’s approach to managing risks. Ensure the organization complies with relevant laws, regulations and industry standards related to risk management and safety. Performs other related duties Required Skills/Abilities: Strong knowledge of healthcare regulations and accreditation standards Excellent communication, problem solving and interpersonal skills. Ability to collaborate with cross functional teams. Diligence and a commitment to promoting a culture of safety. Ability to assess potential risks to prioritize them based on their impact and likelihood. Strong analytical skills to collect and interpret data, perform risk analysis, and make data driven decisions. Proficiency in developing and implementing risk mitigation strategies. Ability to identify problems, analyze their root causes and develop creative solutions to mitigate or eliminate risk. Proficiency in crisis management and the ability to respond effectively to unexpected events or emergencies that pose a risk to the organization. Education and Experience: Bachelor’s degree in nursing, juris doctorate, or related field Master’s Degree preferred Certification in risk management preferred. Minimum of 5 years of experience in healthcare risk management or a related field ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

Conduct audits and reviews to ensure compliance with healthcare laws and company policies, communicate findings, maintain compliance reporting, and manage audit schedules. | 5+ years in healthcare compliance auditing or related roles, knowledge of Medicare/Medicaid coding rules, healthcare compliance certifications preferred, strong communication and analytical skills. | Audit Analyst, Compliance, Privacy & Risk Management Job Summary: The Audit Analyst for Compliance, Privacy & Risk Management is responsible for the oversight and management of auditing and monitoring high-risk, problem prone processes, completing compliance risk assessments to ensure compliance with federal/state laws and regulations, and ArchWell Health policies. Duties/Responsibilities: • Adheres to assigned audit schedule and reviews as outlined in the Compliance Workplan • Assists with reviewing internal and external inquiries regarding compliance and privacy matters, including government and third-party payor requests. • Conducts audits and focused reviews to ensure compliance with company, government, and payor guidelines. • Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. • Assists with maintaining regular and consistent governance-level reporting and metrics for the Compliance department, including but not limited to dashboards, board reporting, weekly, monthly, and annual compliance & ethics reporting. • Maintain a working knowledge of HIPAA, HHS, and CMS regulations. • Participate in the planning and scheduling of compliance projects. • Research compliance related questions upon request from departments and/or practices. • Identify and report potential audit and compliance risks. Required Skills/Abilities: • Knowledge of Medicare and Medicaid documentation and coding rules and guidelines. • Must have an understanding and knowledge of national and state laws and regulations • Must have excellent verbal and written communication skills. • Strong interpersonal skills • Strong organizational and planning skills. • Demonstrates a high degree of personal integrity and practice ethical standards. • Demonstrates proactiveness and ability to work independently and self-directed in managing multiple concurrent projects. • Excellent analytical and problem-solving skills. • Advanced skills in all MS Office applications (Word, Excel, Outlook, and PowerPoint). • Ability to interpret and apply documentation and coding rules and regulations. • Ability to demonstrate competence in performing audits, produce reports, formulate remediation or mitigation plans, and conduct follow-up audits. Minimum Qualifications: • Equivalent of 5+ years’ experience in compliance auditing, clinical chart reviews, medical necessity review/auditing, revenue integrity, and/or health care compliance • Experience in compliance and privacy auditing techniques and methods • Certified in Healthcare Compliance (CHC) or Certified in Healthcare Privacy Compliance (CHPC) preferred • Bachelor's degree in related field preferred • Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) preferred At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life. Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members. ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.