RN, Clinical Physician Concierge - Archimedes

Navitus Health Solutions•Earth City, MO

About The Position

Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit – alignment, value and transparency – Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost. .______________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. Overview The RN, Clinical Physician Concierge will be responsible for delivering clinical messages to physicians around the prior authorization program for specified populations. This role will need to be able to identify and manage high-touch prescribers and members and usher the prescriber through the prior authorization process. This position will also be responsible for being a clinical expert for physician inquiries. The RN, Clinical Physician Concierge will interface with the prior authorization and account management teams to monitor all identified members in specific populations that qualify for physician concierge.

Requirements

High school diploma or GED required.
Current nursing license (RN) in good standing with a State Board of Nursing required.
Pharmacy and Medical specialty benefit knowledge and experience required.
3 years clinical or managed care experience required.
Proficient in Microsoft Excel, Power Point and Word.

Nice To Haves

APRN preferred.

Responsibilities

Review chart notes and perform utilization management review on patient/drug specific case basis.
Coordinate prior authorization for members’ specialty drug treatment, ensuring timely delivery to the appropriate site of care.
Handle case assignments, review case progress, properly document case notes and determine case closure.
Manage high touch cases, ensuring all members are cared for in preparation for therapy administration.
Manage specific client populations, tracking all members and their mapping next steps to ensure optimal member care.
Follows established procedures, processes, and standards for production, productivity, quality, and customer service.
Meets performance targets for speed, efficiency, and quality.
Complete care management clinical escalations.
Escalate to account management as appropriate.
Ensure all external and internal customers receive the level of customer service required by Archimedes and serves as a representative of Archimedes to all external customers.
Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
Other duties as assigned