RN: Medication Access & Prior Authorization Specialist

Mercycare; Cedar Rapids, Northern (IA, KY); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Mercy is seeking an experienced RN with specialty/ambulatory care background to manage medication access, prior authorizations, denials, and appeals. You will coordinate with providers, patients, payers and pharmacies to ensure timely therapy initiation and ongoing management.

The ideal candidate has gastroenterology or specialty nursing experience, familiarity with biologics and high-cost medications, and knowledge of PBMs, CoverMyMeds, and EHR workflows to track access from request to approval.

Qualifications

• RN licensure in Iowa or a compact state required.
• Experience with specialty meds and prior authorization processes preferred.
• Strong knowledge of denials, appeals, formulary and step-therapy requirements.

Responsibilities

• Coordinate the full medication-access process from PA submission through denials and appeals.
• Work with providers, patients, payers, and pharmacies to move treatment forward.
• Document patient encounters and manage medication requests/changes/refills per protocol.
• Provide patient education and discharge instructions when appropriate.

Skills

Specialty or gastroenterology nursing

Biologic/high-cost medications PA

Prior authorizations knowledge

Denials/appeals/peer-to-peer

PBMs, specialty pharmacies & insurance

EHR medication workflows & CoverMyMeds

Tracking medication access from start

Education

RN licensure (Iowa)

Tools

CoverMyMeds

EPIC/EHR

Job description

Mercy is seeking an experienced RN with specialty/ambulatory care background to manage medication access, prior authorizations, denials, and appeals. You will coordinate with providers, patients, payers and pharmacies to ensure timely therapy initiation and ongoing management.

The ideal candidate has gastroenterology or specialty nursing experience, familiarity with biologics and high-cost medications, and knowledge of PBMs, CoverMyMeds, and EHR workflows to track access from request to approval.