Referral & Authorization Care Coordinator

Oshi Health – Clinical Operations Care Coordinator: Prior Authorizations & Referrals

Are you passionate about patient care and looking to work as part of a multidisciplinary care team to improve the digestive health of a large population on a national scale?

Are you ready to create a revolutionary new approach to digestive health care with a radically better patient experience while bending the cost curve down?

Do you share our belief that telehealth and data-driven remote care can provide more accessible, convenient, supportive and whole-person approaches to diagnosing, treating and controlling symptoms for GI conditions?

Do you thrive in a rapidly evolving, fast-paced environment requiring creativity, resourcefulness, high energy and an ability to adapt quickly?

If so, you could be a perfect fit for our team! We are a group of like-minded professionals who share a common mission and passion for helping others and a desire to build an industry-leading service in the GI space.

About Oshi Health

Oshi Health is revolutionizing GI care with a digital clinic model that provides easy, convenient access to an integrated and multidisciplinary care team that takes a whole-person approach to diagnosing, managing and treating digestive health conditions.

We take time to get to know each patient, develop a personalized, whole-person care plan that includes identification of symptom triggers and prescription of evidence-based interventions, including medications, dietary changes, and mental health support. Our care is delivered virtually through our app, via secure messaging and telehealth visits. When in-person diagnostics or procedures are needed, we take a concierge approach and coordinate access, care and follow up with local providers. For more information, visit us at:

We are seeking a Care Coordinator that specializes in back office responsibilities including but not limited to referral management, prior authorizations, specialty pharmacy & infusions, and medical records to help deliver and implement clinical strategies and assist in member care coordination in collaboration with a multidisciplinary clinical team. As a core member of the clinical team, you will utilize a high level of attention to detail, organization, and communication skills to help obtain, manage, and follow up on member referrals and prior authorizations to ensure key care plan goals are met. A strong ability to manage multiple priorities, knowledge of CPT and ICD-10 codes and proficiency in navigating the prior authorization process will contribute to positive member outcomes of safe and highly efficient care delivery. You will have access to ongoing training and support from a GI focused team to help you develop an expertise with digestive health conditions.

What you’ll do?

• Engage in external coordination of pharmacy support services to ensure members receive all necessary support services available throughout the prior authorization process
• Responsible for the coordination, tracking and communication of patient referrals, prior authorizations, and medical records to promote team awareness and patient safety
• Prioritize incoming referral, medical record requests, and authorization requests according to urgency
• Provide complete and accurate registration of referrals and authorizations including patient demographics, current insurance information and clinical documentation to external providers and specialty pharmacies
• Initiate appeals for denied authorizations and maintain close follow up to ensure positive member outcomes
• Apply knowledge of CPT and ICD-10 codes to obtain authorizations in a timely manner while demonstrating understanding of payer medical policy guidelines
• Ensure comprehensive communication and expectations are explained to the member throughout the referral and authorization process
• Collaborate with a multidisciplinary team of care providers (including MDs, NPs, RDs, Behavioral Health Providers, and Health Coaches) to provide a whole-person approach to member care.
• Manage key reports and track relevant data to identify successes and drive refinements in operational processes.
• Partner with the Clinical Operations leadership team to define and help iterate on strategies for member care coordination
• Offer proficient knowledge of referrals, insurance requirements and the prior authorization process to internal and external resources, to eliminate barriers to care execution and provide follow up on progress toward meeting key goals.
• Assist members in accessing services, providing personalized customized customer service and support while maintaining close communication with members of the care coordination team.
• Openness and ability to cross-train in additional care coordination tasks and responsibilities to support full cycle member engagement

Who You Are?

• Excellent verbal and written communication skills required.
• Ability to provide occasional weekend coverage required.
• Must be able to work Monday through Friday 10am - 6pm EST with ability to work at minimal 2 weekend days per month.
• Fluent in healthcare terminology or working understanding of clinical concepts.
• Minimum of 2-3 years experience working in a healthcare coordination, care or case management role, preferably in a digital healthcare environment
• Background knowledge in navigating health insurance plans and coverage on the part of patients. Must be able to provide breakdown of benefits analysis to consumers.
• Comfortable and competent with using common administrative technologies (e.g. Zoom, Slack, Office or equivalent), charting electronically in EMR/EHR systems , experience delivering on telehealth platforms preferred.
• Excellent customer service qualities required.
• Completed a degree in a health and science related field, i.e. biology, psychology, health science and nutrition, nursing, etc
• Needs to be able to work in a cross-functional interdisciplinary modality and effectively create solutions for complicated patient concerns.

What you'll bring to the team?

• Operate with high integrity and accountability for results
• Ability to solve problems, think outside-the-box, and be resourceful
• Well organized, ability to manage multiple projects at once, eye for details, and collaborate within and across teams
• Thrive in entrepreneurial environment, comfortable with ambiguity, and confident in making decisions
• Must be result-oriented, a quick learner and self-starter
• Ability to roll up your sleeves to get things done yourself, as well as work in a cross-functional team environment

Why Work At Oshi?

We’re revolutionizing GI care — and our employees are driving the change. We’re a hard-working and fun-loving team, committed to always learning and improving, and dedicated to doing the right thing for our members. To achieve our mission, we invest in our people:

We make healthcare more equitable and accessible:

• Mission-driven organization focused on innovative digestive care
• Thrive on diversity with monthly DEIB discussions, activities, and more
• Virtual-first culture: Work from home anywhere in the US
• Live our core values: Own the outcome, Do the right thing, Be direct and open, Learn and improve, Team, Thrive on diversity

We take care of our people:

• Access to a “Life Concierge” through Overalls, because we know life happens
• Competitive compensation with a starting pay range of $45,000-$52,000
• Tailored professional development opportunities to learn and grow
• Employer-sponsored medical, dental and vision plans

We rest, recharge and re-energize:

• Recognition of professional and personal accomplishments
• Unlimited paid time off — take what you need, when you need it
• Team events, such as virtual cooking classes, games, and more
• 13 paid company holidays to power down

Oshi Health is an equal opportunity employer that is committed to creating a diverse work environment. To do that, we champion a workplace where each and every person is treated with dignity and respect and is valued for their unique perspective and contributions.

Oshi Health’s policy is to maintain a working environment that encourages mutual respect, promotes harmonious and congenial relationships between employees, and is free from all forms of discrimination and harassment of any employee (or applicant for employment or service provider) by anyone, including supervisors, co-workers, vendors, or clients. Harassment and discrimination in any manner or form is expressly prohibited. There is no tolerance for discrimination or unequal treatment of any kind on the basis of race, color, religion, creed, gender, sex, sexual orientation, gender identity or expression, pregnancy, sexual and reproductive health decisions, national origin, age, disability, genetic information, marital status or civil partnership/union status, familial status, military or veteran status, predisposition or carrier status, domestic violence victim status, alienage or citizenship status, unemployment status, sexual violence or stalking victim status, caregiver status, or any other characteristic protected by law.

This practice applies to all terms, conditions and privileges of employment including, but not limited to, recruitment, selection, promotion, demotion, transfer, layoff, rehire, termination of employment, development and training, compensation, benefits and retirement.

For more information, visit us at

Powered by JazzHR

H36lB3eAHZ