Nurse Clinician RN (Cross Functional)
Location: Whitestown Indiana
Description: Express Scripts is currently seeking to employ Nurse Clinician RN (Cross Functional) right now, this job will be placed in Indiana. More complete informations about this job opportunity kindly read the description below. -
130005S4
Advance your career with the company that makes it easier for people to choose better health.
Express Scripts is a leading ! healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.
ABOUT THE DEPARTMENT
Our Enterprise Operations Management and Integration Division (EOMI) enables the organization to reach its business goals by optimizing operational performance. They accomplish this through a shared service model, utilizing specialized resources and providing cross-fu! nctional insight to ensure quality and consistency for our mem! bers and clients.
This group is made up of several key teams including Strategic Initiatives, Quality Monitoring, Audit Relations and Training, Analytics and Process Improvement and Service Delivery.
JOB DESCRIPTION
The Nurse Clinician รข€" RN is responsible for reviewing escalated clinical criteria reviews for providers, members and patient client advocates within the Prior Authorization/Utilization Management department. Identify and track trends for analytics reporting to ensure clinical criteria program integrity. Maintain a professional and ethical behavior at all times as outlined by the Nurse Practice Act and applicable company policies.
ESSENTIAL FUNCTIONS
Perform escalated clinical review and analysis of clinical program descriptions for clinical and criteria integrity.
Maintains contact database and responds to member and physician inquiries regarding clinical programs. Makes recommendations regarding escalation! of issues, and follows through with escalation process.
Acts as liaison between clients, patients and patient care advocates to provide guidance on clinical criteria.
Performs initial clinical review and analysis of prior authorization cases based on state regulations.
Special projects/assignments as needed.
MINIMUM QUALIFICATIONS
Registered Nursing Licensure
2-5 years experience in a clinical setting
General PC knowledge including Microsoft Office, Internet and email
Previous clinical criteria review experience preferred; Active professional affiliations and/or national certification in related clinical specialty preferred; Able to work flexible work schedule
Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or ! status as a disabled veteran or veteran of the Vietnam era, pregnancy, ! affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class.
None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics.
Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.
Job Category
General
Primary Location
United States-Indiana-Whitestown
Work Locations
Whitestown, IN - 4750 East 450 South
4750 East 450 South
Whitestown
46075
Schedule
Full-time
Shift
Any
Employee Status
Regu! lar
Travel
No
Work From Home?
No
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Express Scripts.
If you interested on this job just click on the Apply button, you will be redirected to the official website
This job starts available on: Thu, 24 Oct 2013 18:27:05 GMT
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