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