Remote Member Care & Clinical Coordination Specialist

Calibrate Health, Inc.; United States; Remote; USD 28,000 - 30,000; Full time

Benefits offered by this job

Paid time off

Medical, dental & vision benefits

Disability & life insurance

Headspace membership

Headspace Care therapy

Job summary

Calibrate Health, Inc. is seeking a Member Care Coordinator who sits at the intersection of Member Experience and Clinical Operations. This full-time, hourly role ensures timely, coordinated, high-quality care and acts as the glue between Clinical, Coaching, and Operational teams, including tracking lab results and medication approvals.

Remote-first with ET shifts; pay $20–$22 per hour. You will manage end-to-end medication access, PA submissions, and follow-up, while logging activity in the

Qualifications

• Completion of a formal medical assisting program is highly valued.
• Familiarity with case management systems (e.g., Zendesk), EHR, and PA/e-prescribing platforms is highly desirable.
• 2+ years of high-volume customer service, call center, or patient advocacy experience, preferably in a healthcare, pharmacy, or PBM setting.
• Demonstrated track record of managing complex, multi-step processes where follow-up and persistence are critical to success.
• Exceptional verbal and written communication skills with the proven ability to handle challenging, escalated calls/messages with professionalism and empathy.

Responsibilities

• Execute critical clinical administrative workflows focusing on resolving readiness barriers to accelerate members toward provider review and medication access.
• Facilitate provider workflow efficiency by preparing clinical documents and proactively triaging member needs for specialty support.
• Facilitate structured handoffs of critical information to Clinical and Coaching teams to ensure timely follow-up regarding changes in medication, denials, or approved exception paths.
• Engage in cross-functional meetings and work collaboratively with others departments to improve and maintain a high level of member care.
• Identify and formally report recurring systemic issues, submission errors, or trends that contribute to operational friction.
• Manage the end-to-end medication access workflow with complete ownership, including the proactive gathering of relevant clinical data, coordinating with clinicians for additional necessary information, complex Prior Authorization (PA) submission, denial investigation, appeal documentation, final determination and overrides when applicable.
• Proactively contact members via phone and secure message to request necessary information (e.g., previous prescription history, documentation) and deliver clarity regarding complex PA status changes or delays.
• Conduct outbound calls to insurance carriers, PBMs, and pharmacies to obtain specific case statuses, track documentation, and secure approvals.
• Ensure all communication, investigation notes, and PA statuses are accurately logged in the case management system (e.g., Zendesk, MJD) to maintain a complete and auditable member record.
• Initiate and resolve pharmacy-level rejections (e.g., refill too soon, insurance coding errors, wrong dose dispensed) by conducting outbound calls to dispensing pharmacies and PBM help desks.
• Troubleshoot technical or administrative insurance issues that prevent successful claims processing.

Skills

Customer service

Communication

Case management experience

Healthcare familiarity

Education

Medical assisting program

CMA/RMA certification

Tools

Zendesk

EHR systems

PA/e-prescribing platforms

Job description

Calibrate Health, Inc. is seeking a Member Care Coordinator who sits at the intersection of Member Experience and Clinical Operations. This full-time, hourly role ensures timely, coordinated, high-quality care and acts as the glue between Clinical, Coaching, and Operational teams, including tracking lab results and medication approvals.

Remote-first with ET shifts; pay $20–$22 per hour. You will manage end-to-end medication access, PA submissions, and follow-up, while logging activity in the