Blue Cross Rn Remote Jobs in West Virginia (NOW HIRING)

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The RN will be an integral part of the AON Adherence Program, providing medication and disease advice to patients. The AON RN will assist prescribers in obtaining Celgene Auth. numbers, provide REMS (Risk Evaluation and Mitigation Strategy) safety information to AON patients, will act as a resource to the Prior Authorization Team and will complete patient oral oncolytic appeals on behalf of AON.

KPA 1 - Patient Adherence:

• Educate patients and (when appropriate) family regarding medications

• Educate patients on side effects and treatment plans

• Interact with patient and family in a caring, professional manner

• Perform reassessments and refill requests to assure proper continuation of treatment

KPA 2 - REMS Authorizations and safety information.

• Responsible for assisting the clinicians in obtaining Celgene Auth. Numbers

• Responsible for completing the clinical education and counseling portion of the FDA REMS program for required medications.

• Must become certified by Celgene and maintain current certification

KPA 3 - Prior Authorizations

• Will serve as a clinical and prior authorization resource to the Prior Authorization Team

• Will participate in reviewing denied, unclear, or questionable PA requests according to applicable clinical criteria as defined by regulatory and compliance requirements

• Will review and initiate prior authorization appeal services to include first level appeal reviews. Will coordinate appeal reviews with Medical Director(s) of pharmacy benefit managers and/or peer-to-peer interviews as required

KPA 4 - Customer Service

• The RN must have the skills required to handle escalated calls or email requests that may arise in the pharmacy to help maintain a smooth workflow and ensure turnaround times are met for each patient

• Thorough and accurate documentation in OncoEMR, CPR+, and patient adherence software

• Must demonstrate ability to work independently with minimal supervision, however when required able to work well in a team setting.

KPA 5 - Training and Education

• Provide ongoing training and quality assurance activities to the Prior Authorization and Pharmacy Team

• Attend all mandatory pharmacy staff meetings and educational dinner meetings as necessary

Education: Registered Nurse (associate's or bachelor's degree)

Previous Experience:

• Experience in oral oncology therapy is required

• Licensed or eligible in the State of Florida

• Knowledge of oral chemotherapy prior authorizations and/or appeals preferred

Core Capabilities:

• Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detailed oriented with the ability to exercise independent judgment.

• Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.

• Communication Skills: Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.

• Customer Service & Organizational Awareness: Strong customer focus. Ability to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations.

• Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability work independently with limited supervision. Ability to work remotely effectively as required.

• Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.

• Computer Skills:

  • Proficiency in MS Office Word, Excel, Power Point, and Outlook required.

Certifications/Licenses:

• RN

Remote: Yes

Standard Work Days/Hours: Monday to Friday 9:00 AM - 5:30 PM.

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