Clinical Authorization and Appeals Specialist

Responsibilities

• Educates health care providers regarding prior authorization and appeals criteria for prescribed therapies.
• Affirms clinical documentation provided and assists the health care provider with alignment to specific plan criteria.
• Creates initiatives to increase patient adherence and optimize patient care.
• Possesses a broad and deep understanding of assigned disease states, products, and clinical programs.
• Closes collaboration with program team members as well as external stakeholders.
• Performs appropriate and accurate documentation of cases using call management software.
• Demonstrates appropriate judgment skills to be able to make independent clinical decisions.
• Fosters teamwork by trusting and supporting each other while encouraging collaboration at all levels of the organization.

Qualifications

• Associate degree or bachelor’s degree from an accredited nursing school as a Registered Nurse (RN).
• Must have demonstrated competence in community health or patient care setting, providing direct patient care with patients for 1-3 years.
• Strong writing and grammar skills.
• Strong organizational skills and a thorough knowledge of computers (Microsoft Office and Windows) are required.
• Demonstrated ability to work independently and meet goals.

Benefits

• Hybrid, remote and flexible on-site work schedules are available, based on the position.
• PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program!
• Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees.
• Of course we offer paid holidays too!