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We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

                                    

Job TitleUtilization Management RN - Specialty Pharmacy

                        

LocationBeachwood

                    

FacilityCleveland Clinic Administrative Campus

                     

DepartmentSpecialty Pharmacy-Pharmacy

                      

Job CodeT98481

                     

ShiftDays

                       

Schedule7:00am-6:00pm

                       

Job Summary

                         

Job Details

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.   

As a Utilization Management RN, you will provide a high level of patient care and clinical support to individuals enrolled in the Specialty Pharmacy Patient Management Program. Your responsibilities will include coordinating and obtaining prior authorizations for medication coverage, managing appeals, reviewing patient charts, conducting follow-up assessments to monitor adherence and side effects, providing patient counseling and offering injection training as needed. You may also contribute to the development and implementation of special projects under the direction of the Manager.

A caregiver in this role works remote in Ohio, rotating day shifts between 7:00 a.m. – 6:00 p.m.

A caregiver who excels in this role will:

Provide prior authorization support for Specialty medications specific to disease state as assigned.

Prioritize and organize work to meet changing priorities.

Utilize analytical ability required to gather data and use clinical judgment to apply predetermined criteria or use independent clinical judgment when no predetermined criteria exist to identify problems and facilitate resolution.

Use independent clinical judgment in reviewing records to determine appropriate off label use of specialty medication. If proper procedures have been followed, appropriate escalation of PA denials through the appeals process.

Make recommendations regarding appropriateness of the treatment plan specific to the nurse’s assigned disease state.

Contact Physician’s office regarding questions, concerns or problems with the prescription before providing authorization support to other groups so that errors or discrepancies are corrected early in the workflow, making the process more efficient for other groups.

Complete prior authorizations for assigned patients with a minimum as deemed appropriate by Manager.

Apply clinical studies or guidelines accurately to monitor appropriateness of medications specific to each disease state.

Follow department guidelines on escalation processes and refer cases appropriately to pharmacists, teams and managers.

Maintain professional work standards including confidentiality, ethical principles and professional work habits.

Maintain and support collaborative relationships with Physicians and the multidisciplinary team.

Document appropriately in Epic Specialty Encounter notes to provide evidence that the Prior Authorization process for the case was followed.

Attend all staff meetings when scheduled to work.

Minimum qualifications for the ideal future caregiver include:

Graduate of an accredited school of nursing with licensure as a Registered Nurse (RN) in the State of Ohio

Current valid license in the State of Ohio as a Registered Nurse (RN)

Three years equivalent full-time clinical experience as a Registered Nurse

Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures and basic disease processes

Analytical ability required to gather data, decide on conformity based on predetermined criteria, identify problems and refer for resolution

Proficient with Microsoft Office and Epic

Knowledge of prescription benefit and prior authorization requirements for specialty medications, adequacy of documentation, and ability to conduct research of issue at hand, as well as formulate recommendations based on findings; capable of providing in-service education to health care providers on this topic

Knowledge of licensing and accreditation standards

Preferred qualifications for the ideal future caregiver include:

Bachelor of Science in Nursing

Prior Utilization Management experience

Experience in Oncology

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/

Physical Requirements:

Requires walking, sitting, and/or standing for long periods of time.

Requires constant attention to detail, reading of medical records, and meeting deadlines.

Works in an environment where there is some discomfort due to dust, noise, temperature.

Personal Protective Equipment:

Follows standard precautions using personal protective equipment as required

                       

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System's Smoking Policy will be permitted to reapply for open positions after one year.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

Please review the Equal Employment Opportunity poster. 

                  

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities