California Licensed Telephonic Nurse

Job Summary

Supporting healthcare providers and patients through telephonic interactions, the full-time California Licensed Telephonic Nurse will manage inbound and outbound calls, conduct clinical reviews, and assist with prior authorization and appeals while working remotely.

Key responsibilities

• Provide telephonic support to healthcare providers and patients, ensuring adherence to program-specific guidelines
• Review payer product coverage criteria and denial letters, troubleshooting complex reimbursement cases as needed
• Document and communicate effectively regarding patient inquiries, outcomes, and clinical notes while participating in team training and meetings

Required qualifications

• Associate degree and a valid Registered Nurse License in California, with a willingness to obtain additional licenses as required
• Previous experience in the PBM or healthcare industry, preferably in a telephonic clinical role
• At least 2 years of customer service experience in a call center environment with advanced issue resolution skills
• Proficiency in Microsoft Office applications, especially Excel, and strong analytical skills
• Ability to thrive in a fast-paced environment, demonstrating strong attention to detail and effective relationship-building skills