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UBC - Utilization Review Nurse - LPN

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POST DATE 9/9/2016
END DATE 10/26/2016

Express Scripts Saint Louis, MO

Company
Express Scripts
Job Classification
Full Time
Company Ref #
REQ20004112
AJE Ref #
576122596
Location
Saint Louis, MO
Experience
Entry Level (0 - 2 years)
Job Type
Regular

JOB DESCRIPTION

APPLY
Schedule: Full-time

Job ID: REQ20004112

POSITION
SUMMARY:

The Utilization Review Nurse LPN is primarily
responsible for providing clinical criteria support to providers, members and
patient client advocates within the Prior Authorization/Utilization Management
department. This position is responsible for maintaining professional and
ethical behavior at all times as outlined by licensing guidelines and company
policies.

ESSENTIAL
FUNCTIONS:

* Review prior authorization requests against
clinical criteria to assess and evaluate clinical information and client
specifications. Ensure compliance and adherence to policies and procedures to
service clients and patients by required service guarantees.
* Provides
day to day oversight and coordination of case load to ensure parties
responsible for task are completing them timely. Role does not have direct HR reporting
responsibilities
* Acts
as a primary resources for patients, healthcare providers and field
reimbursement
* Serves
as an expert in the program business rules and Acthar referral process,
including providing instruction to HCP s on how to submit a clean referral
* Identifies
problematic quality trends (internally or externally) works on resolution,
recommends solutions or escalates as appropriate
* Performs
quality checks on cases and reports trends to leadership

QUALIFICATIONS:

* 0-2 years experience in a clinical setting
* Licensure- Practical Nurse

* General PC knowledge including Microsoft
Office, Internet and email
* Knowledge of pharmacy, pharmaceuticals, or
healthcare business required; Ability to analyze and interpret clinical
criteria; Works effectively across organization and fosters teamwork;
Demonstrates the ability to manage production independently while building
strong credible working relationships with clients, patients and internal
partners; Excellent communication skills both verbal and written; Demonstrated
knowledge of medical terminology and capacity to thoroughly analyze clinical
criteria; Active professional affiliations and/or national certification in
related clinical specialty preferred; Ability to work flexible work schedule.

QUALIFICATIONS:

* 0-2 years experience in a clinical setting

* Reimbursement and utilization review experience preferred
* Licensure- Practical Nurse

* General PC knowledge including Microsoft
Office, Internet and email
* Knowledge of pharmacy, pharmaceuticals, or
healthcare business required; Ability to analyze and interpret clinical
criteria; Works effectively across organization and fosters teamwork;
Demonstrates the ability to manage production independently while building
strong credible working relationships with clients, patients and internal
partners; Excellent communication skills both verbal and written; Demonstrated
knowledge of medical terminology and capacity to thoroughly analyze clinical
criteria; Active professional affiliations and/or national certification in
related clinical specialty preferred; Ability to work flexible work schedule.

*LI-TB1

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.
ABOUT UBC

United BioSource Corporation (UBC) is the leading provider of integrated development and commercial support solutions that deliver evidence of safe use, while optimizing access to mediation and care.

UBC leverages our specialty pharmacy therapy expertise and contracts for specialty pharmacy and specialty distribution services.

UBC's services include reimbursement, patient assistance and alternate funding programs, channel optimization through specialty pharmacy, specialty distribution and 3PL services, Customized clinical adherence and commercialization strategies powered by Express Scripts data.

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.