Pre-Cert Pharmacy Review Nurse, RN – Pharmacy Experience Required

🕒 May 20

🏈 Ohio – Remote

🏈 Ohio – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

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Quantum Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1999

⚕️ Healthcare Insurance

💳 Fintech

💰 Private Equity Round on 2020-11

Healthcare Insurance • Fintech • AI

Quantum Health is a healthcare navigation company that simplifies the healthcare experience by providing comprehensive care solutions and personalized member support. The company focuses on improving clinical and financial outcomes for its clients by guiding members to quality care and optimizing health benefits. With a tech-empowered approach, Quantum Health uses real-time technology to proactively engage members and ensure a smooth healthcare journey, ultimately delivering significant cost savings and enhanced satisfaction for both employees and employers.

📋 Description

• Clinically review all requests for provider-administered specialty medications for appropriateness • Support providers and members in optimization of site of care for requested services • Demonstrate and expand a working knowledge of all clinical processes and medical policy • Work collaboratively with Medical Directors and Pharmacists for all relevant requests • Serve as a Subject Matter Expert (SME) for infusible and injectable medication-related services • Communicate with members, providers, facilities, and all internal work groups regarding outcome of requests • Identify members who may be appropriate for care/case management services • Identify care coordination opportunities and work with operational, clinical, and customer-facing teams

🎯 Requirements

• Bachelor’s degree in nursing or closely related field or equivalent experience • Current and active and unrestricted license as a Registered Nurse (RN) in the state of Ohio • Minimum of 2 years of managed care and/or direct care nursing experience required • Experience with Specialty Pharmacy/Pharmaceuticals required • Experience with Utilization Management required • Makes clinical decisions quickly and at times decides and acts with limited information • Excellent critical thinking skills • Strong interpersonal, verbal and written communication skills • Self-directed, organized with excellent time management skills • Excellent computer skills including Microsoft applications • Strong administrative/technical skills

🏖️ Benefits

• Health, vision and dental insurance • Life insurance • Legal and identity protection • Adoption assistance • EAP and Teladoc services • 401(k) plan with up to 4% employer match and full vesting on day one • Paid Time Off (PTO) • 7 paid holidays • Parental leave • Volunteer days • Paid sabbaticals • Tuition reimbursement up to $5,250 annually • Certification/continuing education reimbursement • Discounted higher education partnerships • Paid trainings and leadership development • Recognition as a Best Place to Work for 15+ years • Modern workplace with a casual dress code