Nurse, Specialty Pharmacy

Meijer Inc. | Grand Rapids, MI

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Posted Date 11/06/2019
Description The Specialty Pharmacy Nurse reviews, authorizes, coordinates, and responds to requests for services for patients. This position also communicateswith providers and their offices, and with patients. Makes decisions based on established policies and procedures, Meijer guidelines, and nursing experience. The Specialty Pharmacy Nurse ensures that prior authorization requests are completed in a timely fashion and ensures that all are conducted using nationally-recognized and evidence-based standards. Participates in Quality Improvement projects, performs audits of clinical records, and assists in preparation for audits and other regulatory activities as directed.

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What You'll be Doing:

  • Document current clinical data within patients; electronic profiles
  • Review prescribed treatment regimens and ensure they meet established guidelines
  • Accurately complete and submit prior authorizations to appropriate insurance plan
  • Review denied prior authorizations and appeal when appropriate.
  • Draft LMN (Letter of Medical Necessity) and/or appeal letters when applicable
  • Work closely with prescribers and prescribers’staff to coordinate patient care during the prior authorization process and/or appeals process
  • Conduct research to build appeal letter
  • Review prior authorizations completed by the Clinical Care Coordinator
  • Work collaboratively with all stakeholders to complete high-touch specialty patient prescriptions through all stages of the specialty patient management process
  • Conduct disease-specific clinical assessments as applicable
  • Promote comprehensive patient care by helping establish patient care goals; by educating patients and caregivers about condition, medication(s), and supportive care ; and by answering questions
  • Assure quality of care by adhering to the philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations
  • Maintain continuity amongst team by documenting and communicating actions, irregularities, and continuing needs
  • Make visits to prescribers’offices as needed
  • Perform other duties as assigned

What You Bring with You (Qualifications):

  • Associates degree or higher from an accredited school of nursing
  • Must hold active license as a Registered Nurse (RN)
  • At least two (2) years Insurance Verification and appeals experience required
  • Previous Medicaid/Medicare experience preferred
  • Prior Authorization review experience preferred
  • Strong organizational skills and a thorough knowledge of computers (Microsoft Office and Windows) are required
  • Demonstrated ability to work independently and meet goals
  • Strong written and verbal communication skills
  • Ability to work in a fast-paced environment while maintaining a positive attitude.
  • Strong oral and written communication skills. Strong team player.
  • Commitment to company values.
  • Willingness to travel/visit physician office when requested by Sales Team

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