Clinical Assistant

Job description

**ABOUT US** At Vida, we help people get better- and we're helping the healthcare system get better, too. Vida 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. Vida'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, Vida 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 Vida’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. **This is a 3 month seasonal position with possibility of extensions based on performance and business needs.** ### 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 Sssistant team and PBM formulary details for operational applications; assist with training team members on complex prior authorization guidelines as needed. - Assist Vida 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 Vida Member Support, Vida 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 Vida’s QA, compliance, and clinical protocol guidelines. - Limit scope of practice to Vida 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.