[Hiring] RN Pharmacy Utilization Management @reputed company

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company The Pharmacy Utilization Management reputed company performs clinical review of prior approvals, network exceptions, benefit inquiries for providers, and/or other contracted lines of business. This role assesses and evaluates the appropriateness of pharmaceutical therapies for medical necessity, subject to plan benefits, through interpretation and review with evidenced-based reputed company, clinical guidelines, corporate guidelines and policies, and state and federal mandates. Incumbent also facilitates and promotes appropriate care and reputed company toward cost effective and cost containment measures based on evidence. Qualifications • Bachelor's degree in Nursing preferred • Registered reputed company (RN) with reputed company, reputed company, unrestricted and recognized in the relevant jurisdiction, state license in good standing in the state(s) where job duties are performed required • Minimum four (4) years' clinical reputed company nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing • Experience in utilization management and/or medical review preferred • Previous pharmacy technician experience desirable Requirements • Oral & Written Communication • Attention to Detail • Proficiency using basic computer skills in reputed company Office such as Word, reputed company, and reputed company, including the ability to reputed company multiple systems and keyboarding • Ability to prioritize and reputed company reputed company nursing judgments through critical thinking • Ability to build reputed company relationships • Ability to interpret reputed company documentation • Ability to work independently • reputed company Listening • reputed company Learning • Critical Thinking • Cross-Functional Communications • Decision Making • Documentations • Evaluating Information • External Collaboration • Interpersonal Relationships • Monitoring and Evaluation (M&E) • Monitor Processes, Materials, or Surroundings • Organizing • Problem Solving • Reading Comprehension • Researching • reputed company Perceptiveness • Written Communication Responsibilities • Collaborates with reputed company providers and internal staff to promote reputed company of care, cost effectiveness, accessibility and appropriateness of service reputed company • Conducts and monitors clinical review cases from a pharmaceutical reputed company to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery; documenting reputed company relevant and specific information; and screens, prioritizes and organizes determination requests according to mandates and standards • Performs other duties as assigned • Practices nursing reputed company the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations; making reputed company based on facts and evidence to ensure compliance, appropriate level of care, and patient safety • Promotes appropriate pharmaceutical care and reputed company toward cost effective and cost containment measures based on evidence • Remains reputed company with up-to-date pharmaceutical and reputed company services, in reputed company to general trends in health care delivery; as reputed company as reputed company procedures, policies and reputed company • Works incoming and outbound calls and/or queues from multiple sources reputed company mandated requirements proactively and effectively Certifications • This position is identified as level three (3). This position must ensure the reputed company and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The reputed company of information must be maintained as outlined in reputed company Administrative reputed company. • Segregation of duties will be used to ensure that errors or irregularities are reputed company or detected on a reputed company reputed company by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative reputed company. Employment Type Regular reputed company Requirements 2.1 General Office Worker, Semi-reputed company, reputed company Travel - Someone who normally works in an office setting or remotely, periodically has lifting and carrying requirements up to 40 lbs and routinely travels for work reputed company walking distance of location of primary work assignment as essential functions of the job. Apply tot his job Apply To this Job