Job Description - This is a Work at Home role - anywhere in the US
Express Scripts Coverage Review Department (CRD)
Role Summary
Nurse clinicians are responsible for reviewing if coverage can be granted for a medication based on guidelines established by each particular plan. Work closely with utilization management pharmacists and physicians.
Responsibilities
- Utilizes multiple systems and other clinical resources to research information
- Applies patient assessment skills to provide pharmacists and medical directors key information to aid in their reviews
- Works and maneuvers within a queue system that prioritizes clinical reviews
- Works and collaborates with a multi-disciplinary clinical team to provide a customer centric experience
Work hours: 8:30 am-5:00 pm; Also, must be available to work every 6th weekend rotation working either Saturday or Sunday, will receive a day off during the week.
Qualifications
- Licensed Registered Nurse
- Bachelor’s Degree in Nursing preferred
- 5+ years of clinical experience; pharmacy knowledge preferred
- Proficient technical skills utilizing Microsoft Office applications required
- Utilization Management Experience Preferred, but not required
- Experience with Specialty Pharmacy/Pharmaceuticals preferred
- 2+ years lead/supervisor experience preferred
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.