Express Scripts Nurse Case Manager - Accredo in St. Louis, Missouri
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.
•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.
•2-5 years experience in a clinical setting.
•Registered Nursing Licensure.
•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
Through the range of healthcare products and services Accredo offers, team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiencies. In addition to the wide range of healthcare products offered to these patients, we provide comprehensive management services, including outcomes measurement, counseling, clinical care management programs, social services and reimbursement services. In these very high-tough roles, employees leave every day knowing they made a positive impact on patient lives.
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.