Cassandra Durham

I've processed high-volume medical and pharmacy prior authorization requests for AmeriHealth Caritas and OptumRx, supporting timely patient care decisions.

At AmeriHealth Caritas, I reviewed clinical documentation, medical records, physician orders, eligibility, benefits, and medical necessity criteria. I used payer portals and Salesforce Health Cloud to submit, track, and update requests.

At OptumRx, I managed pharmacy authorizations from intake through approval, escalation, or closure. I reviewed formularies and insurance policies, routed clinical determinations to Registered Nurses or Medical Directors, and obtained missing clinical information from provider offices.

I'm seeking a remote role where I can apply my authorization workflow management, provider outreach, documentation review, and HIPAA-compliant communication skills.