Clinical Associate

The OccuNet Company is an innovative company striving to reduce the cost of healthcare. We are a passionate group of people that care about affordable access to healthcare without sacrificing experience. We strive to make healthcare more intelligent, streamlined, and cost-effective. We offer industry-leading capabilities on negotiations-driven levers to contain rising healthcare costs while taking an experience-centric approach improving the health and well-being of those we serve. We pride ourselves on our tight knit culture based on the ‘outward mindset’ philosophy, emphasizing empathy, mutual respect, and seeing each other as “whole people.” We have an ambitious vision and are growing quickly. We are seeking team members who are excited about our growth, seeking to thrive in a fast-paced environment, and enthusiastic about developing their skills and career alongside us. 

Job Title:  FairosRx Clinical Associate

Job Summary:  As a Clinical Associate, you will support pharmacy benefit operations by coordinating clinical and administrative workflows, reviewing documentation, and communicating with members, providers, pharmacy staff, clients, and internal stakeholders. The role helps ensure accurate, timely, and compliant processing of pharmacy benefit requests while supporting service quality and operational efficiency.

What it’s Like to Work Here:  At OccuNet, you matter like we matter!  Our team members share a positive attitude, an outward mindset, problem-solving abilities, and patience, enabling them to provide excellent customer service even during challenging situations. Our culture, plus continuous opportunities for growth, has resulted in an industry-low turnover rate. Don’t miss out on this rare opening with us!

A Day in the Life: The FairosRx Clinical Associate will support the clinical team in prior authorization case reviews, complete administrative tasks related to prior authorizations and appeals; support and assist member services, members, healthcare providers, and internal stakeholders with claim resolution, coverage questions, formulary questions and pharmacy benefit determinations. Perform other assigned duties and assist with special projects.

Duties & Responsibilities:

• Collect, verify, and document clinical information from providers, pharmacies, and members.
• Assist pharmacists with utilization management, coverage determinations, and appeals processing.
• Monitor work queues and meet productivity, quality, and turnaround time expectations.
• Process pharmacy claims and resolve claim adjudication issues.
• Research member eligibility, benefit coverage, and medication history.
• Communicate with prescribers, pharmacies, and members regarding authorization status, coverage requirements, and alternative therapies.
• Provide customer service and respond to inquiries related to pharmacy benefits and medication coverage.
• Maintain accurate case documentation in pharmacy management systems.
• Support formulary management initiatives, including step therapy and quantity limit programs.
• Ensure compliance with HIPAA, client requirements, and regulatory standards.
• Maintain confidentiality of protected health information.
• Assist with other duties and special projects as assigned.

Required Skills and Abilities:

• Excellent communication and interpersonal skills, written and verbal, with the ability to adapt appropriately for different audiences.
• Able to multi-task effectively and transition between tasks frequently and maintain focus when presented with interruptions.
• Proficient computer skills, including Microsoft Office Suite.
• PBM experience preferred.
• Team-first mindset with a high level of motivation and drive.
• A track record of fostering collaboration, resolving conflicts and managing projects preferred.
• High school diploma or equivalent.
• Active certified pharmacy technician (CPhT)
• Prolonged periods sitting or standing at a desk and working on a computer.
• Full-time, Monday to Friday 8 am – 5 pm CST.

Ready to apply? If this job sounds like a fit for you, then click on the ‘apply’ button below. Good luck!

 Culture and Opportunities

• We pride ourselves on our outward mindset – supporting each other and putting the team and the clients we serve first
• High-growth environment with clear opportunities for career growth
• Welcoming atmosphere and culture

 Benefits

• 401(k) with matching
• Dental insurance
• Health insurance
• Vision insurance
• Health savings account
• Paid time off