About the job
Schedule: Monday–Friday, 8:00 AM – 5:00 PM
Pay Rate: $45–$50/hour (based on experience)
Overview:
We are seeking an experienced and detail-oriented Registered Nurse (RN) to support prior authorization requests and medication management education in a remote capacity. This role focuses on optimizing medication safety, streamlining access to care, and supporting positive health outcomes—especially for patients managing chronic conditions such as diabetes.
Key Responsibilities:
- Oversee patients’ medication needs from initial review through post-treatment follow-up.
- Conduct thorough medication reconciliations, identify drug-related issues, and escalate safety concerns when necessary.
- Coordinate with pharmacy teams and Pharmacy Benefit Managers (PBMs) to track adverse drug events and ensure proper reporting and follow-through.
- Support the prior authorization process for medications requiring pre-approval by collaborating with prescribers and payers.
- Assist in preparing and submitting appeals for denied medications, providing necessary clinical documentation and supporting the patient’s case.
- Educate patients on medication usage, potential side effects, administration, and recovery timelines.
- Serve as a liaison among patients, providers, pharmacists, and internal teams to ensure clear, timely communication and care coordination.
- Collaborate with utilization management and clinical operations teams to inform workflows, technology use, and policy development.
- Accurately document all assessments, interventions, and communications in accordance with regulatory and payer standards.
- Track medication utilization and adherence metrics; analyze trends to identify areas for process improvement.
- Partner with analytics teams to develop medication-related reports and dashboards.
Requirements:
- Active, unrestricted Texas Registered Nurse (RN) license.
- **Current residence within the state of Texas even though this is remote, current Texas Residence is required due to restrictions).**
- Minimum 2 years of experience in prior authorization or utilization management at a health plan or PBM.
- Strong understanding of PBM processes, medication coverage criteria, and appeals workflows.
- Clinical knowledge in chronic disease management and pharmacotherapy.
- Excellent time management, critical thinking, and communication skills.
- Proficiency with EMR systems, prior authorization tools, and Microsoft Office Suite.