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POST DATE 9/17/2016
END DATE 10/11/2016

Express Scripts Warrendale, PA

Company
Express Scripts
Job Classification
Part Time
Company Ref #
REQ20004297
AJE Ref #
576202161
Location
Warrendale, PA
Experience
Mid-Career (2 - 15 years)
Job Type
Regular

JOB DESCRIPTION

APPLY
Schedule: Part-time

Job ID: REQ20004297

POSITION SUMMARY

The Nurse Clinician 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.

QUALIFICATIONS

* Registered Nursing License
* 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

ABOUT THE DEPARTMENT

The Chief Medical Office is responsible for the integrity of our clinical programs, including leading our Pharmacy & Therapeutics (P&T) committee and Quality Management committee. The area manages Medical Affairs and supports many other departments, including Sales &Account Management, Government Affairs, Pharmaceutical Services, Specialty Pharmacy and Human Resources.

ABOUT EXPRESS SCRIPTS

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.
Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation.
Express Scripts is a VEVRAA Federal Contractor.

Express Scripts is an EOE
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.