Medical Claim Nurse Case Reviewer - Specialty Pharmacy Programs

Organizational Culture and Vision As one of the fastest growing Healthcare Services Companies, there is no better place than Catamaran in which you can join an elite group of professionals to enhance your skills and grow your career.
Our vibrant, fast-paced environment will enable you to pursue opportunities that allow you to collaborate, innovate, and learn.
Overview To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Responsible for the practice of nursing according to the Rules and Regulations defined in the State Nurse Practice Act and the Compact State Nurse Practice Act.
Responsibilities Supports pharmacy patient management programs in the area of planning, scheduling, and coordinating patient and family education by phone related to disease state, specialty medication, appropriate administration, and side effect management.
Assesses spiritual, emotional and educational needs of patients and families during medication therapy.
Assists with incoming specialty medication phone inquiries regarding new enrollments and medication refill coordination.
Supports onboarding and implementation of new members as assigned.
Supports the management of Prior Authorization requests for multiple insurance plans as appropriate.
Provides statistical data related to patient medication compliance, quality outcomes, and program management.
Performs other duties as assigned within scope of practice.
Qualifications Knowledge, Skills, and Abilities (including Core Competencies)Good verbal and written communication skillsStrong teamwork and cooperation skillsStrong organizational skillsProficient in Microsoft Outlook, Excel and Office Word requiredProficient computer and organizational skills with the ability to focus on workload and achievement of both production and quality objectivesEducation and ExperienceBachelor of Science in Nursing preferredLicensed as per Board of Nursing requirements in the State where job responsibilities are performed - license must be active and in good standingMust have multi-state compact licensure, and have the ability to gain licensure in other states as requested.
Three or more years direct patient care experiencePharmacy technician license or registration and National Pharmacy Technician Certification may be required

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