Prior Authorization Management
Complete new and renewal prior authorizations; gather clinical documentation; submit accurate payer forms; monitor determinations; communicate requests for additional information; support appeal preparation; and document final outcomes.
Patient-Assistance and Affordability Navigation
Screen for patient-assistance programs, copay support when permitted, foundation assistance, and internal resources; complete applications; obtain signatures and financial documentation; track approvals and renewals; and communicate next steps to patients.
Marshall Health Network Pharmacy Workflow
Serve as the primary operational link between both Rivers clinics and Marshall Health Network pharmacies; confirm prescription receipt; resolve missing information; coordinate payer-required routing; support internal dispensing when eligible; and maintain closed-loop communication until medication access is completed.
High-Cost and Specialty Medication Focus
Prioritize high-cost therapies, including biologics and specialty agents, as well as other medications with significant prior-authorization, specialty-pharmacy, or affordability requirements.
Patient Communication
Provide non-clinical updates regarding authorization status, required documents, pharmacy routing, assistance-program status, and next steps. Clinical questions will be escalated to the pharmacist or prescribing team.
Data Tracking and Reporting
Track volume, approval rate, turnaround time, patient-assistance activity, estimated patient savings, internal capture, leakage reasons, abandoned prescriptions, and time to first fill. Provide routine reports to Ambulatory Clinical Pharmacy leadership.
Marshall Health is the largest, most comprehensive health care provider group in our region. Our patients are treated by a team of healthcare professionals that includes the region's top physicians and researchers and benefit from the latest diagnostic and treatment facilities.
Marshall Health delivers world-class care to our community in every setting--from clinics and labs to a major teaching hospital.
When you choose a Marshall Health provider, you become a part of the Marshall team, helping us teach medical students and provide advanced training to more than 150 resident physicians and fellows who represent the healthcare future of this region.
This is the Marshall Health mission--to achieve medical excellence through educating West Virginia's future physicians, continuing medical research and providing you with quality health care.
