Prescription Nurse Specialist


ABOUT THE POSITION

The Prescription Nurse Specialist, under the supervision of the Director of Nursing, will be responsible for all non-controlled medication refills for all CHCSEK medical providers and may assist with controlled medication refills as needed. This position will also collaborate with Primary and Care Coordinator nursing staff in the prior authorization process. Facilitation of obtaining insurance coverage, securing the prior authorization and notifying the rendering party in the timeliest manner possible so our patient receives the services needed with the least delay.

RESPONSIBILITIES

  • Following the Medication Refill Protocol to ensure patients receive timely refills of medications.
  • Facilitating appointments for patients that may be overdue to continue receiving refills.
  • Communicating between patient and provider to obtain approval for medications not on protocol.
  • For controlled medications (If applicable)-ensuring K-Tracs and PDM are appropriate, contract signed and up to date, refill is on 28 day calendar, last office visit is within time frame directed by provider, refill is due. If all above are met, medication may be refilled in chart and sent to provider to refill via EPCS.
  • Receive request for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.
  • Coordinate and submit medical records to insurance carriers to expedite prior authorization processes.
  • Manage correspondence with insurance companies, physicians, specialist and patients as needed, including documenting in the EHR as appropriate.
  • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
  • Review accuracy and completeness of information requested and ensure that all supporting documents are present.
  • Review denials and follow up with provider to obtain medical necessity information to submit an appeal of the denial.
  • Prioritize the incoming authorizations by level of urgency to the patient.
  • Secure patient information in accordance with CHCSEK policy/procedures.
  • Other duties as assigned.

QUALIFICATIONS

  • Licensed nurse in the state of Kansas.
  • Must be BLS certified.
  • Previous experience in a clinic setting preferred.
  • Base knowledge of medications, insurance processes and medical terminology.

KNOWLEDGE, SKILLS AND ABILITIES

  • Social and cultural sensitivity appropriate to ethnically and economically diverse patient-and employee-base.
  • Communicates through appropriate channels. Use proper chain of command for patient complaints.
  • Ability to handle emergency situations calmly and effectively.
  • Must be computer literate and able to navigate through the Electronic Health Record.
  • Must be able to maintain good inter-personal relationship with co-workers and other members of the health care team and the organization.
  • Provide customer service in accordance to the organization’s mission.
  • Be courteous and respectful when interacting with patients and family members.
  • Maintain patient confidentiality in accordance to organization’s policy and procedure and HIPAA requirements.