Ohio Licensed Pre-Certification Nurse

Job Summary

A company is looking for a Registered Nurse - Pre-Certification Pharmacy Review.

Key Responsibilities

• Review and process coverage determinations and utilization management for specialty medications
• Collaborate with a multi-disciplinary clinical team to optimize site of care and provide a customer-centered experience
• Communicate with members, providers, and internal teams regarding the outcomes of service requests

Required Qualifications

• Bachelor's degree in nursing or a closely related field or equivalent experience
• Current and active Registered Nurse (RN) license in the state of Ohio
• Minimum of 2 years of managed care and/or direct care nursing experience
• Experience with Specialty Pharmacy and Utilization Management
• Ability to make clinical decisions quickly, often with limited information