RN Pharmacy Utilization Management
USABLE MUTUAL INSURANCE COMPANY(24 days ago)
About this role
The Pharmacy Utilization Management Nurse conducts clinical evaluation of prior authorizations, network exceptions, and benefit inquiries to determine the appropriateness of pharmaceutical therapies. The role assesses medical necessity using evidence-based criteria, clinical and corporate guidelines, and state and federal mandates. The position supports cost-effective, quality pharmaceutical care and maintains current knowledge of pharmaceutical and healthcare trends.
Required Skills
- Active Listening
- Critical Thinking
- Decision Making
- Documentation
- Clinical Review
- Utilization Management
- Microsoft Office
- Prioritization
- Interpersonal Skills
- Research
Qualifications
- Bachelor's Degree in Nursing
- Registered Nurse (RN)
About USABLE MUTUAL INSURANCE COMPANY
usablemutual.comUSAble Mutual Insurance Company has a rich history of creating insurance plans and services that fit your life…and your budget.
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