Utilizes evidence based tools to evaluate the prescribed medications to ensure patient safety and quality standards are in alignment with best practice standards.
Performs clinical assessment via information in pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place.
Evaluates patient drug usage and physician prescribing patterns.
Evaluates overuse, underuse and misuse of prescribed medications and may recommend testing to determine if drug diversion is present.
Evaluates need for and recommends alternative treatment.
Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary.
Negotiates appropriate level and intensity of care through use of medical and disability duration guidelines, adhering to quality assurance standards.
Negotiates changes in pharmacy plan with providers.
Acts as a resource in consulting with the client, nursing staff and claims examiners regarding pharmacy issues.
Performs drug utilization reviews through the pharmacy benefit manager or vendor.
Communicates effectively with claims examiner, client, vendor, supervisor and other parties as needed.
Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

Active unrestricted RN license in a state or territory of the United States required.
Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred.
Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
Four (4) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management.

Diverse and comprehensive benefits including medical, dental, vision, 401K, PTO and more beginning your first day.

RN Pharmacy

About this role