About This Role
This role provides frontline clinical triage assistance to existing patients through structured workflows. It involves reviewing clinical tickets, medication refill requests, safety assessments, appointment coordination, and crisis escalation. The position supports medication management, side-effect evaluations, follow-up scheduling, and patient care coordination while ensuring compliance with established clinical protocols. This position is composed of approximately 85% web-based interactions and 15% telephonic patient engagement.
Responsibilities
- Review and triage patient encounters submitted through the program, referred to as Tickets or Triage Job Bins (TJBs), according to established urgency and risk-based protocols
- Assess and prioritize routine, urgent, and high-risk patient concerns using eClinicalWorks (eCW)
- Apply clinical decision trees and standardized workflows for medication refill requests, side-effect assessments, crisis language identification, clinical decompensation concerns, and medication renewal requests
- Route cases to the appropriate provider queues and document all actions taken
- Process medication refill requests in accordance with clinical guidelines and provider instructions
- Conduct Prescription Drug Monitoring Program (PDMP) checks prior to refill authorization
- Identify, evaluate, and document red flags, including multiple providers prescribing controlled medications, early refill requests, and potential medication misuse or diversion
- Escalate concerns requiring provider review or intervention
- Manage both web-based and voice-based patient interactions using Genesys
- Receive inbound calls and conduct outbound follow-up calls as required
- Perform patient identity verification in accordance with organizational policies
- Utilize approved scripts and communication guidelines when addressing medication refill inquiries, side-effect concerns, appointment-related requests, and general patient questions
- Contact patients for clarification, scheduling needs, or medication-related follow-up
- Identify crisis indicators and urgent symptoms, escalating cases immediately according to established protocols
- Assess eligibility and appropriateness for follow-up appointments
- Schedule, reschedule, and manage appointments using internal scheduling platforms
- Coordinate virtual consultations and provider coverage appointments with covering clinicians
- Follow established workflows for patient refusals, cancellations, and no-shows
- Ensure compliance with telehealth regulations and state-specific restrictions related to controlled substances
- Maintain follow-up cadence for urgent and high-priority patient cases
- Complete a minimum of 55 triage tickets per workday while maintaining quality and compliance standards