Pharma Support RN
New
U
UBCPharmaceutical support
United States, 11:00 AM–8:00 PM ET or 12:00 PM–9:00 PM ET; rotating Saturday shift, 9:00 AM–2:00 PM ET, approximately every 5 weeks.Full-TimeJunior
Salary not disclosed
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Job Details
- Experience
- 2+ years ’ experience in a customer service setting.
- Required Skills
- Microsoft ExcelCustomer service
Requirements
- Associate degree and professional nursing license.
- RN license in good standing in the state of residence.
- Hold or be eligible to obtain a Compact Nursing License where applicable, and be willing to obtain a Compact license if the state adopts Compact legislation.
- Obtain and maintain a California RN license through endorsement upon hire; be willing to obtain additional state licenses as required.
- Previous experience in the PBM and/or healthcare industry.
- At least 2 years of customer service experience demonstrating advanced issue-resolution skills, preferably in a call center environment.
- Proficiency in Microsoft Office applications, specifically Excel.
- Ability to research, analyze, prepare reports, and document clearly.
- Advanced problem-solving and troubleshooting skills, including critical thinking.
- Strong attention to detail and relationship-building skills, with the ability to train team members.
- Comfort working primarily on the phone in a computer-based call queue while remaining at a workstation.
- Work the assigned 11:00 AM–8:00 PM ET or 12:00 PM–9:00 PM ET shift, rotating Saturday shifts and select holidays; schedule changes are not guaranteed.
- Travel one week during training and occasional business travel during the year; no planned time off during the 8-week training period.
Responsibilities
- Provide telephonic support to healthcare providers and patients through inbound and outbound calls and virtual calls.
- Review payer coverage criteria and denial letters to identify documentation required for coverage determinations.
- Complete clinical reviews of prior authorization and appeal submissions and communicate missing information using approved resources.
- Troubleshoot complex reimbursement cases, investigate data, identify trends, and resolve escalated issues with internal and external stakeholders.
- Document follow-up calls, patient inquiries, outcomes, clinical notes, and medical-record or chart reviews as applicable.
- Gather, analyze, and prepare data for Quarterly Business Reviews and client meetings.
- Report patient adverse drug events in accordance with manufacturer requirements.
- Participate in program-specific customer meetings, training sessions, and manufacturer-hosted conferences.
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