Member Care Coordinator, Clinical at Calibrate

New York, New York, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Obesity Treatment, Metabolic HealthIndustries

Requirements

Completion of a formal medical assisting program (highly valued)
National certification such as Certified Medical Assistant (CMA) by AAMA or Registered Medical Assistant (RMA) by AMT (preferred)
Familiarity with case management systems (e.g., Zendesk), Electronic Health Records (EHR), and PA/e-prescribing platforms (highly desirable)
2+ years of high-volume customer service, call center, or patient advocacy experience, preferably in healthcare, pharmacy, or PBM setting
Demonstrated track record of managing complex, multi-step processes where follow-up and persistence are critical

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 other 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 proactive gathering of relevant clinical data, coordinating with clinicians, 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

Key technologies and capabilities for this role

clinical administrationcare coordinationlab results trackingmedication approvalsprovider workflowtriagecross-functional collaborationmember experienceclinical operationshand-offs

Questions & Answers

Common questions about this position

What is the salary for the Member Care Coordinator role?

This information is not specified in the job description.

Is this Member Care Coordinator position remote?

This information is not specified in the job description.

What skills are required for the Member Care Coordinator position?

Key skills include executing clinical administrative workflows, managing end-to-end medication access including Prior Authorization submissions and appeals, proactive communication with members via phone and secure message, and accurate logging in case management systems like Zendesk.

What is the company culture like at Calibrate?

The culture emphasizes collaboration across Clinical, Coaching, and Operational teams, with Member Care Coordinators acting as the 'glue' to ensure seamless member care, participating in cross-functional meetings, and identifying systemic issues to improve operations.

What makes a strong candidate for the Member Care Coordinator role?

Strong candidates excel in coordinating complex clinical workflows, managing medication access with ownership including PA submissions and appeals, proactively triaging member needs, and collaborating cross-functionally to resolve operational friction.

Calibrate

Health-tech startup for sustainable weight loss

About Calibrate

Calibrate focuses on sustainable weight loss by improving metabolic health instead of relying on traditional dieting methods. Their program combines gradual habit changes with medication that targets biological factors affecting weight. This approach is based on extensive research and claims to be the first to achieve a 15% sustained weight loss in real-world settings. Calibrate operates on a subscription model, often supported by employers as part of employee wellness programs, but individuals can also join. The program utilizes GLP-1 medications, which help with inflammation, digestion, metabolic function, and cardiovascular health. Calibrate stands out from competitors by offering a non-restrictive, easy-to-maintain program with a money-back guarantee, reflecting their confidence in its effectiveness. The company's goal is to promote long-term health and wellness through a scientifically-backed approach to weight management.

New York City, New YorkHeadquarters

2020Year Founded

$152.3MTotal Funding

GROWTH_EQUITY_VCCompany Stage

Biotechnology, HealthcareIndustries

201-500Employees

Benefits

Competitive salary with opportunity for equity in an early stage, high growth business

Generous paid time off, including an all-company holiday over Thanksgiving week

Calibrate-funded health benefits (medical, dental, vision) - starting at zero cost to you

One Medical membership and Teladoc virtual care

Fertility, gynecology, and wellness services through Kindbody

Therapy on your time with a free year of Talkspace membership

Health advocacy and assistance services through Health Advocate

Commuter benefits, ClassPass memberships, and gym memberships for post-pandemic life

Remote team with a headquarters in NYC

Competitive Paid Parental Leave for parents

Risks

Reliance on GLP-1 medications leads to patient complaints and refund issues.

Selling to Madryn Asset Management suggests potential financial instability.

New CEO may introduce strategic changes disrupting current operations.

Differentiation

Calibrate combines FDA-approved medication with a holistic curriculum for weight loss.

The program offers 1:1 virtual coaching sessions for personalized support.

Calibrate focuses on metabolic health rather than traditional dieting methods.

Upsides

Growing interest in personalized medicine boosts demand for Calibrate's tailored weight loss approach.

Increasing employer investment in wellness programs expands Calibrate's corporate market.

Telehealth models enable Calibrate to reach a broader audience effectively.

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