Pre-Cert Pharmacy Review Nurse, RN – Pharmacy Experience Required
Job Description:
- Clinically review all requests for provider-administered specialty medications for appropriateness
- Support providers and members in optimization of site of care for requested services
- Demonstrate and expand a working knowledge of all clinical processes and medical policy
- Work collaboratively with Medical Directors and Pharmacists for all relevant requests
- Serve as a Subject Matter Expert (SME) for infusible and injectable medication-related services
- Communicate with members, providers, facilities, and all internal work groups regarding outcome of requests
- Identify members who may be appropriate for care/case management services
- Identify care coordination opportunities and work with operational, clinical, and customer-facing teams
Requirements:
- Bachelor’s degree in nursing or closely related field or equivalent experience
- Current and active and unrestricted license as a Registered Nurse (RN) in the state of Ohio
- Minimum of 2 years of managed care and/or direct care nursing experience required
- Experience with Specialty Pharmacy/Pharmaceuticals required
- Experience with Utilization Management required
- Makes clinical decisions quickly and at times decides and acts with limited information
- Excellent critical thinking skills
- Strong interpersonal, verbal and written communication skills
- Self-directed, organized with excellent time management skills
- Excellent computer skills including Microsoft applications
- Strong administrative/technical skills
Benefits:
- Health, vision and dental insurance
- Life insurance
- Legal and identity protection
- Adoption assistance
- EAP and Teladoc services
- 401(k) plan with up to 4% employer match and full vesting on day one
- Paid Time Off (PTO)
- 7 paid holidays
- Parental leave
- Volunteer days
- Paid sabbaticals
- Tuition reimbursement up to $5,250 annually
- Certification/continuing education reimbursement
- Discounted higher education partnerships
- Paid trainings and leadership development
- Recognition as a Best Place to Work for 15+ years
- Modern workplace with a casual dress code
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