RX Lock-In Registered Nurse

Job Summary:

The Pharmacy Lock-In Program RN is responsible for appropriately identifying members from multiple referral points for inclusion in the Lock-In Programs.

Essential Functions:

• Verify eligibility, previous enrollment history, demographics and current health status of each member
• Maintain current and accurate tracking and documentation of enrollment in Lock-In Programs
• Coordinate with pharmacies and providers as required
• Complete monthly Lock-In Programs State specific reporting
• Review and maintain the members transferred from other MCO’s to CareSource , adding members transferring from another managed care plan or fee for service Medicaid to Lock-in Program at CareSource
• Prepare case reviews and participate in State Hearings
• Collaborate with Lock-In Programs work groups about members proposed or enrolled in Lock-In Programs
• Participate in meetings with providers to inform them of Lock-In Program, case management services and benefits available to members
• Collaborate with Case Management team to ensure requirements of Lock-in Program are understood and communicated to all involved team members
• Coordinate with Lock-In Program Care Managers about members enrolled in Lock-In programs and their providers across the continuum of illness
• Evaluate projects, processes and procedures for continuous  improvements
• Routinely collaborate with multiple departments to manage Lock-In Programs projects, escalations and initiatives
• Provide education and support to pharmacy department about lock-in programs
• Make appropriate referrals to other care management programs
• Collaborate with other departments, including, but not limited to SIU, Medical Management, Provider Relations, Claims, Regulatory and Care Management
• Consult with Medical Directors and Physician experts when necessary
• Collaborate with the members of an inter-disciplinary team to meet the needs of the individual and the population
• Serve as a Subject Matter Expert  (SME) for current and new staff and serve as a resource of knowledge
• Perform any other job duties as requested

Education and Experience:

• Completion of an accredited registered nursing (RN) degree program  is required
• Bachelor of Science in Nursing (BSN) is preferred
• A minimum of five (5) years of clinical experience is required
• Behavioral Health clinical experience is preferred
• Substance abuse experience/pain management experience preferred

Competencies, Knowledge and Skills:

• Proficiency level with Microsoft Office, including Outlook, Word and Excel
• Computer skill awareness and willingness to learn new software and systems
• Ability to communicate effectively with a diverse group of individuals
• Proven self-leadership skills
• Decision making and problem solving skills
• Customer service-oriented
• Ability to multi-task and work independently and within a team environment
• Collaborate with team members to optimize outcomes for members
• Critical listening and thinking skills
• Knowledge of local, state and federal healthcare laws and regulations and all company policies regarding case management practices
• Adhere to code of ethics that aligns with professional practice
• Strong advocate for members at all levels of care
• Strong understanding and respect of all cultures and demographic diversity
• Ability to interpret and implement current research findings
• Awareness of community and state support resources
• Strong organizational and time management skills

Licensure and Certification:

• Current, unrestricted registered nurse (RN) licensure  in State of practice is required
• Case Management certification or Certified Managed Care is highly preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$55,350.00 - $88,560.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Ot