Pre-Certification Review Nurse
2 weeks ago
The Pre-Certification Review Nurse - Pharmacy is a critical member of our clinical team, responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications. This role requires a strong working knowledge of clinical processes and workflows, as well as employer benefit plans.
Key Responsibilities- Review and process all requests for specialty medications and site of care assessments.
- Maintain a working knowledge of all clinical processes and workflows, as well as all employer benefit plans.
- Work with Medical Director/Physician reviewer and Pharmacy Services team for all requests requiring physician review.
- May serve as a Subject Matter Expert (SME) for a clinical process or content area.
- Communicate with members, providers, facilities, and internal work groups regarding the outcome of requests.
- Identify care coordination opportunities and work with clinical teams as needed.
- Active license as a Registered Nurse (RN) in the state of Ohio.
- Bachelor's degree in nursing or closely related field or equivalent experience.
- Minimum of 2 years of direct care nursing experience.
- Ability to obtain additional licenses, as needed.
- Strong working knowledge of Network Medical guidelines.
- Experience with Specialty Pharmacy/Pharmaceuticals preferred.
- Excellent critical thinking skills.
- Strong interpersonal skills.
- Excellent verbal and written communication skills.
- Self-directed, organized with excellent time management skills.
- Excellent computer skills, including Microsoft applications.
- Competitive base and incentive compensation.
- Health, vision, and dental benefits, featuring our best-in-class healthcare navigation 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, and more.
- Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings, and leadership development.
-
Pre-Certification Review Nurse Specialist
1 week ago
Dublin, Ohio, United States Quantum Health Full timeJob Summary:We're seeking a skilled Pre-Certification Review Nurse to join our team at Quantum Health. As a key member of our clinical team, you'll play a critical role in ensuring timely and accurate decisions regarding specialty medications for our employer groups.Key Responsibilities:Review and process coverage determinations and utilization management...
-
Pre-Certification Review Nurse
1 week ago
Dublin, Ohio, United States quantum-health Full timeAbout the RoleAt Quantum Health, we're seeking a highly skilled Pre-Certification Review Nurse - Pharmacy to join our team. As a key member of our clinical team, you'll play a critical role in reviewing and processing coverage determinations and utilization management reviews for specialty medications. Your expertise will help ensure that our members receive...
-
RN, Pre-Certification Review Specialist
1 week ago
Dublin, Ohio, United States quantum-health Full timeAbout the RoleThis position is a key member of our clinical team, responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications. The successful candidate will have a strong background in nursing and experience with clinical processes and workflows. They will work closely with Medical Directors...
-
Senior Tax Reviewer
1 month ago
Dublin, Ohio, United States Astorg & Jones CPAs AC INC Full timeJob DescriptionAstorg & Jones CPAs AC INC is a well-established accounting firm known for providing comprehensive tax, accounting, and advisory services to a diverse clientele. Our commitment to excellence and integrity has earned us a reputation for delivering high-quality services and building long-term client relationships.We are currently seeking an...
-
Travel Nurse RN Position
3 weeks ago
Dublin, Ohio, United States Travel Nurse Across America Full timeTravel Nurse Across America is seeking a qualified Catheterization lab RN for a travel nurse assignment in a traveler-friendly facility. This opportunity offers excellent pay, benefits, bonus opportunity, travel reimbursement, and more. The ideal candidate will have a minimum of 1-2 years' experience and hold certifications such as ACLS and BLS. Additional...
-
Operating Room Registered Nurse
4 weeks ago
Dublin, Ohio, United States Travel Nurse Source Full timeJob SummaryTravel Nurse Source is seeking a skilled Operating Room Registered Nurse (OR RN) to join our team in Dublin, Ohio. As an OR RN, you will play a vital role in the surgical team, providing direct patient care before, during, and after surgical procedures.Key ResponsibilitiesPreoperative Preparation: Assess patients' medical histories and current...
-
Travel Nurse RN
1 week ago
Dublin, Ohio, United States Travel Nurse Source Full timeAbout the PositionTravel Nurse Source is partnering with ICONMA, L.L.C. to find a qualified Home Health RN in Dublin, Ohio.Job SummaryWe are seeking a skilled Home Health RN to join our team in Dublin, Ohio. As a Home Health RN, you will provide high-quality patient care in a home setting. This is a 13-week contract opportunity with a reputable healthcare...
-
Travel Nurse RN Position
2 weeks ago
Dublin, Ohio, United States Travel Nurse Source Full timeAbout the PositionTravel Nurse Source is working with ICONMA, L.L.C. to find a qualified Home Health RN in Dublin, Ohio.Job SummaryWe are seeking a skilled Registered Nurse to join our team in a Home Health setting. The ideal candidate will have experience in home hospice care and possess a strong commitment to delivering high-quality patient...
-
Travel Nurse RN
7 days ago
Dublin, Ohio, United States Travel Nurse Source Full timeAbout the PositionWe are seeking a skilled Stepdown Registered Nurse to join our team at a reputable healthcare facility in Dublin, Ohio. As a Stepdown RN, you will be responsible for monitoring patients who require frequent assessment but are not unstable enough to need care in a critical setting.Key Responsibilities:Monitor vital signs and detect changes...
-
Travel Nurse RN
1 week ago
Dublin, Ohio, United States Travel Nurse Source Full timeAbout the JobWe are seeking a skilled Home Health RN to join our team at Trustaff, a leading travel nursing agency. As a Home Health RN, you will provide high-quality patient care and support in the comfort of patients' homes.Responsibilities:Visit patients in their homes to provide treatment and palliative careMonitor patients' conditions and report on...
-
Practical Nurse(Acute Care Specialist)
2 weeks ago
Dublin, Ohio, United States Veterans Affairs, Veterans Health Administration Full timeJob SummaryThe Licensed Practical Nurse (LPN) will function as a member of the Teamlet and/or support for specialty clinic(s) within the Community Based Outpatient Clinic (CBOC). The Teamlet is comprised of the Primary Care Provider, RN Care Manager, Clinical Associate (LPN, MA, or Health Tech) and clerk working within the Patient Aligned Care Team (PACT)...
-
Travel Nurse RN
7 days ago
Dublin, Ohio, United States Host Healthcare Full timeJoin Host Healthcare as a Registered Nurse - Pre-Op in Dublin, OHHost Healthcare is a leading travel healthcare company with a strong reputation for providing exceptional opportunities for healthcare professionals. We are currently seeking a skilled Registered Nurse - Pre-Op to join our team in Dublin, OH.About the RoleAs a Registered Nurse - Pre-Op, you...
-
Certified Registered Nurse Anesthetist
4 weeks ago
Dublin, Ohio, United States Dorner Plastic Surgery & MedSpa Full timeSeeking a Skilled CRNA for Part-time PositionGrowing Surgery Center is a leading healthcare provider seeking a skilled Certified Registered Nurse Anesthetist to join our team. As a CRNA, you will play a crucial role in providing high-quality anesthesia care to patients across Cosmetic Plastic Surgery and Interventional Pain.Responsibilities:Collaborate with...
-
Practical Nurse(Acute Care Specialist)
3 weeks ago
Dublin, Ohio, United States Veterans Affairs, Veterans Health Administration Full timeJob SummaryWe are seeking a highly skilled Licensed Practical Nurse (LPN) to join our team at the Veterans Affairs, Veterans Health Administration. As a key member of our Patient Aligned Care Team (PACT), you will provide exceptional care to our patients in a dynamic and supportive environment.ResponsibilitiesMonitor and capture workload credit, develop...
-
Travel Nurse RN
4 weeks ago
Dublin, Ohio, United States HealthEcareers - Client Full timeJob SummaryHealthEcareers - Client is seeking a skilled Operating Room Nurse to join their team as a travel nurse. This is a fantastic opportunity for a dedicated and compassionate nurse to work in a dynamic environment and make a meaningful difference in the lives of patients.Job ResponsibilitiesProvide high-quality patient care in the operating room...
-
Nurse Practitioner
6 days ago
Dublin, Ohio, United States Ohio Gastroenterology Group Full timeJob Title: Registered NurseWe are seeking a highly skilled and experienced Registered Nurse to join our team at Ohio Gastroenterology Group. As a Registered Nurse, you will play a vital role in providing exceptional patient care and contributing to the success of our endoscopy department.Responsibilities:Assess and monitor patients' physical and psychosocial...
-
Travel Nurse RN
3 days ago
Dublin, Ohio, United States Cynet Health Full timeJob Title:Registered Nurse - Stepdown/IntermediateJob Summary:Cynet Health is seeking a skilled Registered Nurse to join our team as a Travel Nurse RN. This 13-week assignment will take place in a Stepdown/Intermediate unit, where you will work as part of a flexible team providing high-quality care in various regional healthcare...
-
Travel Nurse RN
4 weeks ago
Dublin, Ohio, United States Planet Healthcare Full timePlanet Healthcare is seeking a skilled travel nurse RN for an outpatient surgery position in a dynamic healthcare environment.Job SummaryWe are looking for a dedicated and compassionate travel nurse RN to join our team in providing high-quality patient care in an outpatient surgery setting.ResponsibilitiesProvide exceptional patient care and support to...
-
Chronic Hemodialysis Nurse
2 weeks ago
Dublin, Ohio, United States APR Consulting Full timeJob Title: Chronic Hemodialysis Registered NurseWe are seeking a skilled and experienced Chronic Hemodialysis Registered Nurse to join our team. As a key member of our healthcare team, you will be responsible for providing high-quality patient care and ensuring the safe and effective delivery of hemodialysis therapy.Responsibilities:Perform ongoing,...
-
Nurse Practitioner
7 days ago
Dublin, Ohio, United States Columbus Springs - Dublin Full timeColumbus Springs Dublin Job OpportunityWe are seeking a passionate and patient-centric Registered Nurse to join our team at Columbus Springs Dublin, a nationally recognized healthcare organization. Our team provides compassionate behavioral health services, including crisis stabilization, inpatient care, and outpatient treatment for acute mental health and...