Registered Nurse II

Position Title: Registered Nurse II

Work Location: Remote

Assignment Duration: 8+ months

Work Schedule: 9a-5:30pm EST M-F (30 min unpaid lunch)

Work Arrangement: Remote

Position Summary:

No direct patientcare. This is a virtual position.

Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers.

Key Responsibilities:

• Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers.
• This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc.
• The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial.
• Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients.
• The system leveraged for this coding is a web-based platform proprietary to ESI, and selected contractor will be trained on how to leverage this platform.
• Additionally, the individuals should have strong skills with Microsoft office, particularly Excel.
• Configuration support will be for both pharmacy and medical criteria and will require good creative problem solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency.
• Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal business partners.

Qualification & Experience:

• Requires RN license.
• Communication, Microsoft Office, Organization, Self-Driven, Collaboration
• Demonstrates 'Team Player' and collaborative skills within internal and external teams
• Takes risks by thinking strategically about problems and challenges within their domain
• Communicates effectively within peer group and subordinate groups
• Holds oneself accountable for designated client relationships and the delivery of requests associated to service
• Capable of & develops robust operational controls to maximize service levels
• Able to identify the needs of clinical system or process changes to help enhance service levels
• Ability to comprehend and articulate the importance of assigned responsibilities and controls
• Able to mitigate concerns of business partners within direct scope of responsibility
• Able to clearly communicate directly with clients when providing consultative services