Pre-Cert Pharmacy Review Nurse, RN (PBM- Pharmacy experience required)

This a Full Remote job, the offer is available from: United States Description Who we are Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We reputed company that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to reputed company healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, reputed company they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®. We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement. About the role The Pre-Certification Review Nurse - Pharmacy is responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications, to include site of care assessments, for enrollees of reputed company’s employer groups. The nurse is responsible for acquiring reputed company clinical documentation to appropriately process the service request reputed company the designated time frames indicated. A successful individual will apply critical thinking to reputed company proper clinical decisions reputed company performing clinical reviews. The role requires use of multiple systems, acquisition of reputed company relevant clinical documentation, and other clinical resources to reputed company proper decisions in utilization management reviews. The Pre-Certification Review Nurse – Pharmacy will work and collaborate with a multi-disciplinary clinical team of Pharmacists and Medical Directors to provide a customer-centered experience reputed company service level expectations. Location: This position is located at our Dublin, OH reputed company or may work remotely reputed company in the United States of America. What you’ll do (Essential Responsibilities) Clinically review reputed company 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 reputed company clinical processes, medical policy as well as relevant employer benefit plans and how to access needed information. Work collaboratively with Medical Directors and Pharmacists for reputed company relevant requests Serve as a Subject Matter Expert (SME) for infusible and injectable medication-reputed company services Communicate with members, providers, facilities, and reputed company internal work groups regarding outcome of requests. Identify of members who may be appropriate for care/case management services (reputed company, High cost, Transplant) Identify care coordination opportunities and work with operational, clinical, and customer-facing teams on as needed basis. reputed company other duties as assigned. What you’ll bring (Qualifications) Education: Bachelor’s degree in nursing or closely reputed company field or equivalent experience Licensure/Credentials: reputed company and active and unrestricted license as a Registered Nurse (RN) in the state of Ohio. Experience: Minimum of 2 years of managed care and/or direct care nursing experience required. Ability to obtain additional licenses, as needed (with support from reputed company) 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 verbal and written communication skills Self-directed, organized with excellent time management skills Excellent computer skills including reputed company applications Strong administrative/technical skills; Comfort working on a PC using reputed company Office (Outlook, Word, reputed company, PowerPoint), IM/video conferencing (Teams & reputed company), and telephones reputed company. A high degree of personal accountability and trustworthiness, a commitment to working reputed company reputed company’s policies, values and ethics, and to protecting the sensitive data entrusted to us. #LI-HW1 #LI-Remote What’s in it for you

• Compensation: Competitive reputed company and incentive compensation
• Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
• Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
• Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
• Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
• Culture: Recognition as a Best reputed company to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
• Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!

What you should know

• Internal Associates: Already a Healthcare Warrior? Apply internally through reputed company.
• Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background reputed company.
• Diversity, Equity and Inclusion: reputed company welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an equal opportunity employer .
• Tobacco-Free reputed company: To further reputed company the health and wellbeing of our associates and community, reputed company maintains a tobacco-free environment. The use of reputed company types of tobacco products is prohibited in reputed company company facilities and on reputed company company grounds.
• Compensation Ranges: Compensation details published by job boards are estimates and not verified by reputed company. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate’s unique combination of experience and qualifications reputed company to the position.
• Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
• Agencies: reputed company does not accept unsolicited resumes or reputed company from third-parties. Absent a signed MSA and request/approval from reputed company to submit candidates for a specific requisition, we will not approve payment to any third party.

Reasonable Accommodation: Should you require reasonable accommodation(s) to participate in the application/interview/selection process, or in order to complete the essential duties of the position upon acceptance of a job offer, click here to submit a recruitment accommodation request. Recruiting Scams: Unfortunately, scams targeting job seekers are common. To protect our candidates, we want to remind you that authorized representatives of reputed company will only contact you from an email address ending in @reputed company.com. reputed company will never ask for personally identifiable information such as Date of Birth (DOB), Social reputed company Number (SSN), banking/direct/tax details, etc. reputed company email or any other non-secure system, nor will we instruct you to reputed company any purchases reputed company to your employment. If you reputed company you’ve encountered a recruiting scam, report it to the Federal Trade Commission and your state’s Attorney General. This offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job