Clinical Assistant

ABOUT US

At the company, we help people get better- and we're helping the healthcare system get better, too.

The company is a virtual, personalized obesity care provider that uses evidence-based treatment to help patients manage obesity and related conditions like diabetes, high blood pressure, anxiety and depression. The company's team of Obesity Medicine-Certified Physicians, Registered Dietitians, Expert Coaches and Licensed Therapists takes a whole-person approach to care, helping people lose weight, reduce stress and improve their overall health.

By combining advanced technology with top-notch healthcare providers, the company is breaking down the barriers that have historically kept people from getting the best care. It's trusted by Fortune 100 companies, major national payers and large providers to enable their employees to live their healthiest lives.

The Clinical Assistant manages and executes the company’s end-to-end prescribing and prior authorization operations. This role is responsible for navigating complex Pharmacy Benefit Manager (PBM) criteria, handling complex member escalations, and ensuring members gain timely access to prescribed therapies.

We are seeking a proactive candidate with strong leadership capability—someone who demonstrates high autonomy, takes initiative to resolve complex issues, serves as an informal subject matter expert (SME) and mentor to peers, and proactively identifies ways to streamline and complete prior authorization workflows.

Responsibilities

• Prepare, review, and submit accurate, clinical prior authorization requests to PBMs and health plans for anti-obesity medications.

• Autonomously manage complex exception processes and formulary overrides.

• Act as a key escalation point to research, troubleshoot, and resolve complex coverage inquiries coming from Medical Providers, Member Services, Quality Assurance, and Client Success teams.

• Serve as a knowledgeable liaison between Clinical Assistant team and PBM formulary details for operational applications; assist with training team members on complex prior authorization guidelines as needed.

• Assist the company Medical Providers by reviewing and responding to medical provider chat messages.

• Triage messages to appropriate parties as needed.

• Drive timely issue resolution and maintain high standards of communication by adhering to key performance indicators (KPIs) for ticket handling and message reviews.

• Research and address prescribing-related escalations that come from the company Member Support, the company Quality Assurance, Medical Providers, and Client Success.

• Demonstrate strong self-leadership by managing daily workload priorities, monitoring queues, and driving timely turnarounds to maintain team SLAs.

• Partner closely across multi-disciplinary care teams to align on member prescribing plans and medication access status.

• Maintain strict confidentiality and adhere diligently to HIPAA guidelines regarding Protected Health Information (PHI).

• Efficiently leverage Zendesk ticketing workflows, internal tools, and communication templates.

• Accurately document all hours worked utilizing designated ADP pay codes.

• Perform according to the company’s QA, compliance, and clinical protocol guidelines.

• Limit scope of practice to the company clinical and organizational guidelines.

• Perform other clinical support and operational duties as assigned.

Qualifications

• 3+ years of experience focused on prior authorizations or PBM navigation within a medical clinic, specialty pharmacy, health plan, or telehealth environment.

• Proven track record of taking initiative, leading projects or workflow improvements, and mentoring or guiding colleagues without requiring formal direct report management.

• Deep knowledge of prior authorization submission criteria, PBM formulary exception workflows, navigating prescribing protocols, and clinical documentation for cardiometabolic/specialty drugs.

• Excellent written and verbal communication skills with a proven ability to resolve cross-departmental escalations diplomatically.

• Proficiency in electronic health record (EHR) tools, prior authorization platforms (e.g., CoverMyMeds), and cloud collaboration tools (Google Suite, Slack).

• Strong organization, time-management, and analytical skills with the ability to operate independently in a fast-paced environment.

• Able to work within standard business hours supporting operational needs Monday through Friday between 8:00 AM – 8:00 PM (in candidate’s local time zone).

Preferred

• Certified Medical Assistant (CMA), or related healthcare certification.

• Previous experience in a virtual care, digital health, or high-growth startup setting.

• Proficiency in using telehealth technology.

• Ability to multitask and prioritize in a fast-paced environment.

• Compassionate and patient-centered approach to care.

• Strong organizational skills and attention to detail.

The company is proud to be an Equal Employment Opportunity and Affirmative Action employer.

Diversity is more than a commitment at the company—it is the foundation of what we do. All qualified applicants will receive consideration for employment without regard to race, color, ancestry, religion, gender, gender identity or expression, sexual orientation, marital status, national origin, genetics, disability, age, or Veteran status. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law.

We seek to recruit, develop and retain the most talented people from a diverse candidate pool. We don’t just accept differences — we celebrate them, we support them, and we thrive on them for the benefit of our employees, our platform and those we serve. The company is committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans in our job application procedures.

We do not accept unsolicited assistance from any headhunters or recruitment firms for any of our job openings. All resumes or profiles submitted by search firms to any employee at the company in any form without a valid, signed search agreement in place for the specific position will be deemed the sole property of the company. No fee will be paid in the event the candidate is hired by the company as a result of the unsolicited referral.

**the company is authorized to do business in many, but not all, states. If you are not located in or able to work from a state where the company is registered, you will not be eligible for employment. Please speak with your recruiter to learn more about where the company is registered.

Please note: Applicants must be authorized to work in the U.S. as the company is unable to sponsor work visas for any position.

All the company Employees must reside in/be able to work from the U.S.- international work is prohibited. Job postings at the company will remain open through end of year, until filled.

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