Clinical Nurse, Utilization Management - Archimedes

Santa Barbara Cottage Hospital; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

A leading company in specialty drug management seeks a Clinical Nurse to manage high-cost cases and prior authorizations. The role involves developing clinical policies and effectively communicating with healthcare professionals on specialty medications. Ideal candidates will have a solid nursing background, strong communication skills, and a proactive problem-solving approach.

Qualifications

• Must have a nursing license in good standing.
• 3 years clinical or managed care experience required.
• Pharmacy and Medical specialty benefit knowledge preferred.

Responsibilities

• Deliver clinical messages to physicians and clients.
• Manage prior authorization and clinical policy development.
• Evaluate clinical literature and present findings.

Skills

Clinical experience

Communication

Problem-solving

Education

RN, APRN preferable

Current nursing license

Tools

Microsoft Excel

Power Point

Word

Job description

Company

Archimedes

About Us

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.

Pay Range

USD $0.00 - USD $0.00 /Yr.

Work Schedule Description (e.g. M-F 8am to 5pm)

Our Core Business Hours

Overview

Archimedes is a specialty drug management company with industry-leading technology and services that health plans and employer groups can use to manage specialty drug spend. We are expanding our team and looking for a clinical professional who has specialty drug management experience and a passion for cost management. Given our continued growth trajectory, we are looking for a person who can grow with the company.

This role will be divided into two areas: external clinical outreach activities related to high-cost case management and prior authorization of specialty medications, across pharmacy and medical benefits and specialty and traditional drugs. In addition, this role will have the opportunity to evaluate the data to identify actionable opportunities for specialty management and create clinical policies.

The Clinical Nurse is responsible for being the clinical expert for all specialty medications across both the pharmacy and the medical benefit. This individual will be able to successfully communicate with physicians, nurses, pharmacists, and members related to high-cost case concerns, dose management, genetic testing, therapeutic substitutions and cost management related to specialty drugs. Clinical subject matter expert is required to conduct peer to peer consultations with physicians.

Responsibilities

Key Responsibilities:

• Develop and deliver clinical messages to physicians, members, clients, and consultants
• Manage prior authorization, high-cost cases, claims editing and clinical policy development
• Clinical program development including both medical and pharmacy benefit management
• Define, document, and deliver results for plan sponsors.
• Evaluate and summarize clinical literature as well as financial implications related to medication management options
• Ability to present deep clinical and cost effectiveness information as a peer-to-peer consult

Qualifications

Requirements:

• RN, APRN preferable
• Current nursing license in good standing with a State Board of Nursing
• Pharmacy and Medical specialty benefit knowledge and experience
• Independent, proactive, forward-thinking, creative problem solver, results-oriented
• Ability to work well in team environment
• Strong verbal/written communication skills
• Strong physician-facing clinical communication skills
• 3 years clinical or managed care experience
• Microsoft Excel, Power Point and Word proficiency

Location : Address

Remote

Location : Country

US