Medical Review Institute of America, LLC

Pharmacist

• responsible to carry out day-to-day departmental tasks and complete all processes for screening incoming pharmacy review requests
• preparing review information and materials for assignment to appropriate reviewers
• entering pharmacy case review data in the online case summary/tracking system
• receiving and reviewing Reviewer decisions
• completing outreach over the phone to gather additional information for cases
• taking inbound phone calls from medical professionals
• issuing appropriate, timely and accurate review outcome notifications
• completion of pharmacy case review data in the online case summary/tracking system and client system
• To prepare high quality appropriate pharmacy case review information and materials for submission to the reviewers
• To finalize the pharmacy case review process and issue review outcome notifications to appropriate parties of the case
• To serve as a company liaison with clients, reviewers and practitioners/providers/facilities whose services are subject to review
• Screen incoming pharmacy review requests for completeness of materials required to conduct the review of the case
• Prepare, organize, distribute and present records, materials and forms required for a complete pharmacy case review by reviewers
• Identify appropriate reviewers for pharmacy case review assignment including: determine their availability for a review assignment and obtain information for delivery of the case to the Reviewer if applicable
• Contact clients to resolve questions, obtain information, records and/or materials needed for a pharmacy case review and resolve issues about active cases
• Respond to reviewers’ requests for additional information/materials necessary for a review and notify clients and other internal departments of these needs, as applicable
• Complete outreach via fax and over the phone to obtain missing information necessary to issue appropriate clinical decisions
• Receive incoming phone calls from medical professionals checking status on cases and/or providing additional information to decision cases
• Create and maintain an in-house review file for each active pharmacy case
• Respond to inquiries from clients, other entities referring pharmacy cases for review and practitioners/providers/facilities
• Issue oral and written review outcome notifications that comply with standards and requirements for timeliness, content, recipients and accuracy including written notification grammar and spelling as needed
• Research clients’ questions about review processes and/or Reviewer decisions
• Determine the need for additional information or additional review and notify the client and internal departments of these needs
• Support all Quality Management initiatives
• Actively participate in the compliance process and Provider Relations assessment process
• Support all compliance program activities
• Participate in all company meetings and committees as requested
• Adhere to all policies and procedures
• Take feedback and responsibility for performance
• Adapt to the differences of clients
• Maintain a flexible schedule to meet client needs
• Complete other duties and responsibilities as directed
• Collaborate with and cross-train on other teams as needed

Clinical Pharmacy Coordinator

Project Manager

• Drive project management execution using established best practices to facilitate the business meeting organizational goals.
• Guides, mentors, and evaluates internal project team performance within project guidelines
• Creates and executes Project plans and revises appropriately to meet changing requirements and needs
• Plans and schedules Project timelines and milestones using standard project management tools.
• Communicates milestones, timelines, and obstacles throughout the organization
• Manages day-to-day operational and tactical activities of a Project
• Defines the need of resources and works to obtain the needed resources to ensure project completion
• Able to balance priorities and resources to achieve organizational and individual goals
• Successfully engages in multiple initiatives simultaneously
• Shows ability to learn new tools and processes
• Ability to hold the team accountable for hitting deadlines
• Evaluates and reports project outcomes or concerns
• Ensures follow-up with team members to continue to drive projects

Senior Project Manager

Business Development Rep

• Responsible for participating in development and implementation of corporate-wide marketing and sales activities
• Build funnel with leads for clinical review services in the health, pharmacy, third-party administrator, Taft- Hartley plans, employer self-insured, disability and worker’s compensation industries.
• Partners with commercial sales and marketing teams to develop sales opportunities and grow funnel
• Assist Customer Success reps in developing strong customer relationships, meets and exceeds sales targets, and provides world-class customer support
• Partner with regional sales representatives to search out new sales opportunities through new clients or new opportunities with existing clients
• Assist in developing a business strategy to maximize opportunities for clinical service offerings in health, pharmacy and other specialty areas of focus
• Achieve sales target and funnel growth volumes
• Advance sales funnel opportunities by scheduling initial sales calls based on assigned geography, developing new contacts/relationships, and coordinating remote/onsite qualified appointments with sales representatives.

Business Development Representative, Healthcare

Recruitment

• Responsible for the full recruitment cycle, including job posting, sourcing, scheduling, interviewing, extending offers, conducting reference and background checks, and onboarding.
• Partner with hiring managers to determine staffing needs.
• Develop and maintain strong relationships with internal and external stakeholders to achieve staffing goals.
• Serve as a Subject Matter Expert (SME) for the recruiting process.
• Utilize effective and up-to-date recruiting methods to identify and attract high-quality candidates.
• Provide timely updates to candidates and hiring teams throughout the hiring process.
• Develop and maintain advertising programs that leverage the employer brand strategy.
• Support all compliance program activities.
• Collaborate with hiring managers to ensure adherence to all federal and state laws and regulations.
• Manage candidate activity within the applicant tracking system (ATS).

Talent Acquisition Partner

Application Engineer

• Lead, coach, and mentor engineers; foster a culture of ownership, quality, accountability, and continuous improvement
• Drive predictable delivery through effective planning, execution, risk management, and cross-team coordination
• Remove blockers through active technical engagement, including debugging, design reviews, and rapid problem resolution
• Provide architecture and design leadership to ensure solutions are scalable, reliable, secure, and maintainable
• Conduct code and design reviews, reinforcing engineering best practices and sound system design
• Deep dive into complex production issues across frontend, backend, and database layers to restore service and prevent recurrence
• Lead development and ongoing support of NodeJS services/APIs and React web applications with clean, extensible architecture
• Oversee SQL Server data design and performance, including schema design, complex queries, stored procedures, and tuning
• Ensure strong API integration patterns (RESTful and internal services), resiliency, and secure-by-design practices
• Lead engineering execution across Azure and GCP environments, including deployment readiness, operational reliability, and scalability
• Promote engineering practices aligned with hosted and cloud-native architectures, high availability, and operational excellence
• Provide technical leadership for ColdFusion applications (CFML, CFCs, custom tags, modular design), including integration with modern web stacks
• Lead support and modernization of Windows C++ desktop and service-based applications, including debugging, performance optimization, and reliability improvements
• Ensure structured engineering workflows using Git-based version control and disciplined release processes
• Partner closely with QA, Product, Infrastructure, and business stakeholders to maintain high quality and release readiness across environments

Application Engineering Manager

• Our Clinical Pharmacy Technician processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.
• Performs analysis, obtains information, and enters prior authorization data necessary for claims adjudication.
• Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based on clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.).
• Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality.
• Enter prior authorizations into the system and prioritize requests.
• Check formulary alternatives and review tried and failed medications.
• Utilize drug references and verify the drug being requested is indicated and approved for the condition.
• Document all related information regarding the PA approval or non-approval.
• Conform to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision-making.
• Partner with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.
• Analyze, research, and resolve prior authorization processing issues, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from supervisor or clinical pharmacists; and referring unique or high dollar requests to supervisor according to guidelines.
• Coordinate within client system outbound communication to members, physicians, and pharmacies as required to obtain missing information and manage pending requests.
• Document prior authorization-related information and status.
• Make outbound calls to obtain information and answer questions about prior authorization status.
• Protect and maintain confidentiality and privacy of all prior authorization and member information, including following strict protocols for date stamping and storage/security of prior authorization forms and related information.
• Identify and recommend operational improvements.
• Participate in and support all applicable Quality Management initiatives.
• Maintain a flexible schedule to meet client needs, as needed.
• Adhere to all policies and procedures.
• Take feedback and responsibility for performance.
• Adapt to the differences of clients.
• Support all Compliance Program activities.
• Complete other duties and responsibilities as directed

Clinical Pharmacy Technician

Business Intelligence Developer

• Deliver strategic reporting and insights to the C-Suite, Executive Management team, and Board of Directors
• Partner with the business’s functional leaders to develop KPIs, provide ongoing reporting, and analyze the business impact of strategic initiatives
• Understand the key levers of the business and devise new ways to segment and analyze the business
• Provide regular updates to the Executive Team on progress towards goals as well as proactively identify insights and recommendations for improvement
• Work cross-functionally to develop and monitor key performance indicators
• Identify trends, outliers, and obscurities in the data and translate them into actionable insights for functional leaders
• Assist in the creation of Board of Directors presentations with the ability to analyze financial, commercial, and operational data
• Create simple and compelling visuals to demonstrate business performance, trends, and progress
• Design and implement reporting solutions enabling stakeholders to manage the business and make effective decisions
• Create and update dashboards that will power operational teams and decorate hallway monitors
• Foster transparency and dedication to continuous improvement throughout the Company by being a steward of the data-driven culture at MRIoA
• Participate in strategic initiatives to facilitate forecasting business impact and analyzing the results of pilots/ implementations
• Ad hoc data retrieval and analysis

Business Intelligence Analyst

Engineering Manager

• lead, coach, and mentor engineers
• foster a culture of ownership, quality, accountability, and continuous improvement
• drive predictable delivery through effective planning, execution, risk management, and cross-team coordination
• remove blockers through active technical engagement, including debugging, design reviews, and rapid problem resolution
• provide architecture and design leadership to ensure solutions are scalable, reliable, secure, and maintainable
• conduct code and design reviews, reinforcing engineering best practices and sound system design
• deep dive into complex production issues across frontend, backend, and database layers to restore service and prevent recurrence
• lead development and ongoing support of NodeJS services/APIs and React web applications
• oversee SQL Server data design and performance
• ensure strong API integration patterns, resiliency, and secure-by-design practices
• lead engineering execution across Azure and GCP environments
• promote engineering practices aligned with hosted and cloud-native architectures
• provide technical leadership for ColdFusion applications
• lead support and modernization of Windows C++ desktop and service-based applications
• ensure structured engineering workflows using Git-based version control and disciplined release processes
• partner closely with QA, Product, Infrastructure, and business stakeholders

Medical Director

• Perform utilization management case reviews.
• Maintain productivity score per company standard.
• Maintain annual quality score per company standard.
• Complete annual inter-rater reliability testing.
• Train across all queues as requested by MRIoA leadership.
• Complete all client specific training as requested by MRIoA leadership.
• Maintain up-to-date records of case completion if required.
• Consistently show willingness to take cases as requested.
• Demonstrate respect in interactions across the company.
• Consistently submit scheduling requests at least three months in advance.
• Consistently work scheduled hours.
• Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company).
• Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/or administrative team.
• Actively participate in the MRIoA evaluation process (both company and individual).
• Participate in all company meetings and committees as requested.
• Complete other duties as requested or approved by the CEO and/or chief medical officer.
• Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards.