RN Coverage Review Nurse Clinician, Work from Home, Anywhere, USA

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Job Description – This is a Work at Home role – anywhere in the US

Express Scripts Coverage Review Department (CRD)

Role Summary

Nurse clinicians are responsible for reviewing if coverage can be granted for a medication based on guidelines established by each particular plan. Work closely with utilization management pharmacists and physicians.

Responsibilities

  • Utilizes multiple systems and other clinical resources to research information
  • Applies patient assessment skills to provide pharmacists and medical directors key information to aid in their reviews
  • Works and maneuvers within a queue system that prioritizes clinical reviews
  • Works and collaborates with a multi-disciplinary clinical team to provide a customer centric experience

Work hours: 8:30 am-5:00 pm; Also, must be available to work every 6th weekend rotation working either Saturday or Sunday, will receive a day off during the week.

Qualifications

  • Licensed Registered Nurse
  • Bachelor’s Degree in Nursing preferred
  • 5+ years of clinical experience; pharmacy knowledge preferred
  • Proficient technical skills utilizing Microsoft Office applications required
  • Utilization Management Experience Preferred, but not required
  • Experience with Specialty Pharmacy/Pharmaceuticals preferred
  • 2+ years lead/supervisor experience preferred

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 29 – 49 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.

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Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

 Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible.

Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

If you can start right away, please apply below.

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