Coordinates complex medication and infusion site-of-care transitions for members, including provider communication, prior authorizations, records transfer, prescription changes, outreach, and follow-up. Maintains navigation records, tracks outcomes, and supports savings reporting. The role also develops navigation workflows, SOPs, communication templates, escalation pathways, and quality metrics while partnering with clinical leadership in a startup environment.
About Tokaido Health
Tokaido Health is an AI-native medication navigation platform for self-insured employers. We combine infusion site-of-care navigation, formulary optimization, biosimilar switching, fulfillment arbitrage, and embedded clinical intelligence into a single platform. We are a small founding team building from zero, and this is a ground-floor role.
The Role
You are the primary human connection between Tokaido and our members. You will guide patients through infusion site transitions and drug substitutions, coordinating with providers, managing prior authorizations, and ensuring smooth, supportive care.
This hybrid execution-and-strategy role combines direct member and provider coordination with building Tokaido’s foundational navigation workflows, tools, and quality standards. The position offers high growth potential—a full-time role with a navigation team lead opportunity as our client base grows.
What You’ll Do
- Infusion site-of-care navigation: Manage end-to-end transitions from hospital outpatient infusion to ambulatory or home settings, including site vetting, provider coordination, records transfer, prior authorizations, and post-visit follow-ups.
- Member engagement and outreach: Conduct outreach to members identified as candidates for medication optimization across all product modules (infusion SOC, formulary options, biosimilar switches, and fulfillment alternatives). Explain the opportunity, answer questions, and guide members through the process.
- Provider & Care Coordination: Serve as the primary liaison between members and care teams. Coordinate prescription changes, track adherence, and escalate clinical concerns to peer pharmacists and physicians.
- Navigation workflow design: Partner with the CMO and pharmacist to design and refine navigation SOPs, member communication templates, escalation pathways, and quality metrics. Document what works, flag what doesn’t, and iterate.
- Administrative operations: Maintain accurate records in the care management platform, generate reports on navigation outcomes and pipeline status, and support data collection for savings validation and client reporting.
What You'll Own
Navigation is a measurable discipline. You will track and be accountable for:
- Transition completion rate: Percentage of identified infusion SOC candidates who complete a successful site transition.
- Time to first infusion: Days from member consent to first completed infusion at the new site — this captures the full transition speed including PA, logistics, and scheduling.
- Member engagement rate: Percentage of outreach attempts that result in a meaningful member interaction (not just voicemail).
- Member satisfaction: Post-transition NPS or satisfaction score — the member experience is Tokaido’s brand.
What We’re Looking For
Required:
- 2–5 years of experience in clinical navigation, care coordination, patient advocacy, specialty pharmacy coordination, utilization management, or a related healthcare operations role
- Direct experience coordinating care transitions or managing patients through complex healthcare workflows — site-of-care changes, specialty medication onboarding, or similar
- Strong communication skills with members and clinical providers—you can expertly explain and navigate complex medical and pharmacy benefits for members while seamlessly coordinating prescription changes with clinical providers.
- Comfort working with AI-assisted workflows and technology platforms — our navigation tools are AI-powered, and you need to be willing to work alongside them rather than around them
- Startup mentality — you are comfortable building processes from scratch, working without a detailed playbook, and wearing multiple hats as the team grows
- Organized and detail-oriented — navigation requires tracking multiple members through multi-step processes simultaneously without dropping anything
Strongly Preferred:
- Clinical credential (RN, LPN, MA, CPhT) or strong healthcare operations background
- Experience navigating prior authorization and payer review workflows
- Familiarity with specialty pharmacy, biologics, infusion therapy, or home infusion
- Experience building or scaling early-stage navigation or care management programs
- Understanding of benefit designs, PBM operations, and payer clinical structures
- Bilingual in Spanish
Growth Trajectory
As Tokaido scales beyond the first client, the clinical operations team will grow. The navigator role is designed to evolve into a navigation team lead, managing additional navigators who will handle routine member outreach, administrative coordination, and incentive tracking — enabling you to focus on complex transitions, leadership, and care model strategy. You will also have direct input into hiring and structuring your team.
Why This Role is Different
As our first navigator, you will directly shape Tokaido’s care model rather than follow a rigid playbook. Our AI-native platform automates administrative overhead, allowing you to focus on high-touch member support, provider collaboration, and high-value clinical transitions.
If you want to build something meaningful at a company where your input directly shapes the product, this is that role.
Why Tokaido
As Tokaido adds clients, this role grows into a clinical leadership position. You will help hire and manage additional pharmacists, build out a lean clinical governance structure (formulary review protocols, switching criteria, exception handling standards), and shape the clinical intelligence roadmap alongside the CMO and CTO. The next hire on your team will likely be a certified pharmacy technician (CPhT) to handle routine member outreach and formulary-related follow-up, extending your clinical reach without requiring you to be on every call.
Our Values
Momentum is everything · Pioneers, not passengers · It’s (not) complicated · Win-Win-Win · Build a legacy
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