Registered Nurse, Rx Refill and Prior Authorization Specialist- Behavioral Health Navigation Center
Core
Registered Nurse managing prescription refills and prior authorization requests for behavioral health patients.
Role type
Registered Nurse (Rx Refill and Prior Authorization Specialist)
Builds
Prescription refill services and prior authorization approvals
Domain
Healthcare / Behavioral Health / Pharmacy Operations
Required skills
Registered Nurse licensure, Epic Cadence, clinical experience in pharmacy, patient interaction, insurance verification, protocol adherence, escalation workflows
Preferred skills
Bachelor's degree in nursing, leadership or management experience, work from home capability
Technologies
Epic Cadence, electronic health record, prescription refill platforms, telephony, fax
Responsibilities
Process incoming phone and electronic patient medication refills and prior authorization requests; review medical records and specialty-specific protocols to support filling prescriptions; utilize escalatory workflows to notify prescribing providers of non-compliant requests; facilitate correspondence with patients, providers, insurance companies, and pharmacies; monitor prior authorization work queues and obtain insurance eligibility verification; document pertinent information in medical records; serve as Subject Matter Expert and escalation point for clinical questions; collaborate with team members to address patient requests; analyze procedures and suggest improvements.
Seniority
Mid-level, individual contributor with potential for leadership