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Telephonic Nurse Ambassador
Location
United States
Posted
15 hours ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Telephonic Nurse Ambassador
United Biosource Corporation
Role Description Performs as a Clinical Case Manager supporting healthcare providers and patients through telephonic support for client funded contracts. This includes: - Telephonic support to healthcare providers - Review of payor specific coverage criteria - Completing clinical review of prior authorization and appeal submissions - Providing written communication utilizing client approved program resources This role will build and develop strong customer relationships and support all activities that facilitate patient access. Specific job duties: - Adhere to principles as stipulated by program specific contractual agreements and company practices. - Demonstrate clinical competency regarding reimbursement, product, and medical records and will review and train other team members on these concepts. - Troubleshoot complex cases, identify trends (spanning multiple disease-states), investigate data, and resolve escalated issues related to complex reimbursement from both internal and external stakeholders including prior authorization denials and/or appeals. - Perform review of payer product coverage criteria and denial letters for documentation required for submission for coverage determination. - Provide consistent and effective communication with healthcare providers, utilizing approved resources, regarding payer coverage criteria and information that is missing for payor submission. - Professional resource for IB/OB inquiries with focus on data collection, assembling accurate, timely, clear updates and documenting summary of follow up phone calls, patient inquiries, and outcomes including clinical notes and medical record/chart review when applicable. - Gathers, analyzes, and prepares data for Quarterly Business Reviews (QBRs) and/or client meetings. - Participates in program specific customer meetings and training sessions. - Report Adverse Drug Events that have been experienced by the patient in accordance with manufacturer requirements. - Attend manufacturer hosted conferences, customer meetings/training, and QBRs as requested (including requests to travel for in-person attendance). - Special projects and other duties as assigned. Qualifications - Minimum - associate degree and professional nursing license - Registered Nurse License in good standing in the state in which you work, telephonic clinical roles are required to have a Compact State License in eligible states; additionally, employee must be willing to obtain Compact State license at such time as their state elects to adopt Compact legislation - Telephonic clinical roles are required to have a California State License and the employee must be willing to obtain additional Single State Licenses upon request. - Previous experience in the PBM and/or healthcare industry - Competent ability to research, analyze, prepare reports, and document clearly - 2+ years’ experience in a customer service setting demonstrating advanced skills in issue resolution, preferably in a call center environment - Proficient in Microsoft Office applications, specifically Excel - Ability to handle a fast-paced environment and multi-tasking - Strong written and verbal communication skills - Advanced problem solving and trouble-shooting skills including critical thinking - Strong attention to detail and relationship building skills and the ability to train other team members Requirements - This is a highly telephonic nursing role requiring continuous work within an inbound/outbound call queue along with virtual calls. - Nurses must be comfortable spending the majority of their workday on the phone participating in conversations. - This is a desk-based position that requires nurses to remain at their workstation throughout the workday. - Calls are routed through a computer-based phone system and must be answered directly from the queue. - Candidates seeking a flexible, mobile work environment or a role that allows them to be away from their desk for extended periods may not find this position to be a good fit. - Shifts are scheduled within the window of 8:00 AM – 9:00 PM ET. Team members are assigned a 9-hour shift within this range, which includes a 1-hour unpaid lunch break and additional breaks throughout the day. - This role includes a rotating Saturday shift (9:00 AM – 2:00 PM ET) approximately every 5 weeks. Saturday hours are paid as overtime. - Team members may also be required to work select holidays on a rotating basis to support business needs. - Due to training and onboarding requirements, scheduled time off during training cannot be accommodated. - One week during training (accommodated by the business). Benefits - Remote opportunities - Competitive salaries - Growth opportunities for promotion - 401K with company match* - Tuition reimbursement (after 90 days of employment) - Flexible work environment - 20 days PTO - Paid Holidays - Employee assistance programs - Medical, Dental, and vision coverage - HSA/FSA - Telemedicine (Virtual doctor appointments) - Wellness program - Adoption assistance - Short term disability (after 90 days of employment) - Long term disability - Life insurance - Discount programs
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