POSITION: Treatment Navigation Specialist 

Who We Are

OptiMed Health Partners optimizes health outcomes and quality of life through personalized and coordinated care. We have been serving patients for over 30 years with a focus on high-quality care in retail pharmacy, specialty pharmacy, and infusion services. The OptiMed Vision reimagines healthcare solutions to achieve unsurpassed value. Our results-oriented culture fosters learning, providing growth opportunities for our employees and exceptional care for our patients in all 50 states.

The Impact of This Role   

The Treatment Navigator serves as the primary point of contact for members and healthcare providers throughout the treatment navigation process.  This role is responsible for managing inbound and outbound calls,  obtaining required clinical documentation, submitting and processing prior authorization requests, addressing member and provider concerns, and collaborating with internal teams to ensure efficient resolution of issues. The Treatment Navigator must be able to manage a high-volume workload while delivering exceptional customer service and maintaining attention to detail.

What You'll Be Doing 

The duties and responsibilities of the Treatment Navigation Specialist include, but not limited to:

• Serve as a primary contact for members and provider offices regarding treatment access and authorization needs.
• Build and maintain professional relationships with members and healthcare  providers through timely and effective communication.
• Obtain, review, and organize clinical documentation required for treatment  approvals.
• Follow  up with provider offices to collect missing documentation, clarify  clinical information, coordinate treatment servicing and ensure timely  processing of requests.
• Communicate authorization status updates and next steps to members and providers.
• Address and resolve member and provider concerns, inquiries, and escalations in a  professional and service-oriented manner.
• Collaborate  across internal departments to resolve issues, remove barriers, and ensure  seamless workflow execution.
• Maintain  accurate and thorough documentation of all member and provider  interactions within designated systems.
• Manage  a high-volume call queue and workload while meeting quality, productivity, and service expectations.
• Comply with all HIPAA, company, and regulatory requirements.

Skills and Experience You’ll Bring to the Table:

• High school diploma or equivalent required.
• Experience in healthcare, insurance, customer service, call center operations, or a related field preferred.
• Knowledge of prior authorization processes and medical documentation preferred.
• Proficiency with Microsoft Office and multiple computer systems.

Competencies You’ll Bring to the Table:

• Strong verbal and written communication skills.
• Excellent organizational and time-management abilities.
• Ability to multitask and prioritize competing responsibilities.
• Strong problem-solving and critical-thinking skills.
• Commitment to member and provider service excellence.
• Strong attention to detail.
• Adaptability in a fast-paced environment.
• Accountability and ownership.
• Cross-functional teamwork and collaboration.
• Professionalism and empathy.

WORK ENVIRONMENT

This position operates in an office or hybrid environment and involves frequent communication with members and provider offices through high-volume inbound and outbound calls and electronic correspondence. The role requires strong attention to detail, effective workload management, and the ability to prioritize responsibilities in a fast-paced setting.

OptiMed Health Partners provides equal employment opportunities to all employees and applicants 

for employment and prohibits discrimination and harassment of any type without regard to race, 

color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual 

orientation, gender identity or expression, or any other characteristic protected by federal, state or 

local laws.  

This policy applies to all terms and conditions of employment, including recruiting, hiring, 

placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and 

training.