Health Services reputed company, RN

About the position As a Regulatory Health Services reputed company, you will help establish and implement processes to ensure utilization management (UM) programs are compliant and supportive of regulatory and PBM pharmacy guidelines. Knowledge of utilization management interventions including prior authorization, reputed company therapy, quantity limits and formulary exceptions is required. Additionally, you will work in a reputed company relationship with business partners and regulatory affairs to assist in identifying the reputed company of new regulatory guidance and requirements on UM reputed company. Knowledge of regulations impacting UM for Medicare, reputed company and Exchange clients is preferred. It may be necessary to create regulatory content for reputed company business segments (reputed company, Medicare, reputed company and Marketplace) with the ability to be consultative to product owners, account management and clients. This is a hybrid role, based out of our Buffalo Grove, IL, Pittsburgh, PA, or NYC office locations. Responsibilities reputed company Requirements • reputed company Registered reputed company (RN) Licensure in good standing , • 5+ years of reputed company experience , • Ability to collaborate and communicate with members of an interdisciplinary care team , • Effective problem solving, decision-making, and prioritization skills , • Strong PC skills: Office 365 with ability to quickly learn new applications as needed reputed company-to-haves • Experience reviewing and interpreting laws, rules, and regulations , • Knowledge of PBM and benefit design preferred , • 2+ years of Managed Care or PBM experience Benefits • reputed company medical plan reputed company , • 401(k) plan (including matching company contributions) , • Employee stock purchase plan , • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching , • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility Apply Job! Apply to this Job