The Pre-Authorization Medication Review Nurse will process medication requests that require Prior Authorization by the health plan. Together with the Utilization Management Medication Review Technicians, they intake requests, gather clinical information for the Clinical Pharmacy Team to render a determination and notifies the Referring Provider and Member of the decision. For requests that have been denied, the Nurse will compose the Denial Worksheet in preparation for written notification to the Member and Provider. The Medication Nurse will be guided by the Clinical Medication Team Leader and will report to the Central Referral Department’s Supervisor of Clinical Team.
Education, skills and experience:
Current licensure in Florida as a Licensed Practical Nurse.
Minimum of 2 years clinical experience required. Acceptable areas of experience include physician office nursing, Medical Surgical, Pediatrics, OB, ER, ICU, SNF/ALF or Hospice.
Referral prior authorization, pre-certification experience preferred.
Previous experience with Case Management, authorization of services or utilization review preferred.
Knowledge of Medicare criteria and/or other nationally recognized criteria’s preferred.
Exposure to working with an electronic health record system required.
Working knowledge of medical coding helpful.
Strong computer skills and knowledge of Microsoft Word and Outlook required.
Keyboarding skills of at least 20 wpm required.
Location: Florida Health Care Plans, Inc. · UTILIZATION MANAGEMENT
Schedule: Full-time, Monday - Friday 8am - 5pm