St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
The position is hybrid between remote and Broadhead Rd.
The Registered Nurse, Rx Refill and Prior Authorization Specialist- Behavioral Health Navigation Center is responsible for successfully delivering an exceptional patient experience and ensuring patients receive proper prescription refill services. This role will work with the Rx Refill team as an escalation contact for medication refill work queues and medication prior authorization requests. The Registered Nurse, Rx Refill Specialist is responsible for responding to refill requests, following Behavioral Health Navigation Center and pharmacy procedures in refilling medications, and escalating medication concerns and controlled substances to practices and providers. This role will also perform mentoring and support to the team of Rx Refill Specialists.
JOB DUTIES AND RESPONSIBILITIES:
Processes incoming phone and electronic patient medication refills and prior authorization requests using electronic health record, patient engagement tools and prescription refill platforms.
Engages patients in a polite, prompt and compassionate manner during all patient interactions.
Reviews medical records and specialty-specific prescription refill protocols to support filling of prescription when a refill request flags for review.
Utilizes defined escalatory workflows to notify prescribing provider of medication requests that have not met protocol criteria.
Facilitates correspondence with patients, providers, insurance companies and pharmacies as necessary to address medical refill requests.
Monitors prior authorization work queues WQ(s) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure prior authorizations for medications, medical procedures, or testing.
Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary.
Seeks additional information and/or communicates updates to patients and providers as appropriate throughout the prior authorization process.
Engages insurance company representatives and provides required clinical information to secure prior authorization, when necessary.
Documents pertinent information in medical record and may notify patients of overdue visits and/or necessary screenings based on defined protocol.
Escalates medication questions or concerns to leadership and/or designee as necessary.
Collaboratively partners with other team members to promptly address patient requests and/or concerns that may originate in other settings (e.g., Behavioral Health Navigation Center, practice operations, etc.).
Serves as a resource and Subject Matter Expert (SME) for other team members and internal customers, research complex issues, and works with support resources to resolve patient issues.
Serves as an escalation point for clinical questions related to prescription refills and medication prior authorizations; completes escalated Rx refill and medication prior authorization requests.
Collaborates with Behavioral Health Navigation Center to effectively plan, optimize staffing, flex daily staffing and monitor supply and demand to maintain service levels.
Maintains good working relations with various practices to ensure an efficient Rx refill process.
Helps maintain communication to the Behavioral Health Navigation Center related to medication refills, medication refill denials,…