Job Description

Role Purpose

The purpose of the role is to provide effective technical support to the process and actively resolve client issues directly or through timely escalation to meet process SLAs.

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Second Level Pharmacy RNÂÂ(Registered Nurse)

• Monday – Friday, Hours range from 7am-5:30pm CST.

• This is a non-exempt position.

• Level 2 staff work on some Wipro holidays, based on volume needs.

Job description:

• Responsible for working with healthcare professionals to review drug authorization requests.ÂÂ

• Review decisions are based on MHD policy and professional nursing judgment and experience.

• Work in multiple systems to identify information pertinent to accurately perform drug prior authorization reviews.

• This position will assist with providing education and acts as a team lead to call center staff.

• Must understand algorithms and clinical rules associated with the medication under review in order to make a final decision regarding pre-certification of a medication.ÂÂ

• Perform reviews for incoming drug prior authorization requests via fax and some telephone.

Experience:

• Registered Nurse with an Active Missouri Nursing LicenseÂÂ

• Bachelor’s degree in Nursing with a least one year of professional nursing experience or;

• Graduate of school of nursing with at least two years of professional nursing experience

• Varied nursing background and experience (hospital, physician’s office, outpatient facility, UR etc)

• Computer Skills and Utilization Review experience, desired.

• Candidate must have excellent written and verbal communication skills.

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### **Deliver excellent customer service through effective diagnosis and troubleshooting of client queries**

	- Provide product support and resolution to clients by performing a question diagnosis while guiding users through step-by-step solutions

	- Assist clients with navigating around product menus and facilitate better understanding of product features

	- Troubleshoot all client queries in a user-friendly, courteous and professional manner

	- Maintain logs and records of all customer queries as per the standard procedures and guidelines

	- Accurately process and record all incoming call and email using the designated tracking software

	- Offer alternative solutions to clients (where appropriate) with the objective of retaining customers’ and clients’ business

	- Organize ideas and effectively communicate oral messages appropriate to listeners and situations

	- Follow up and make scheduled call backs to customers to record feedback and ensure compliance to contract /SLAs

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### **Build capability to ensure operational excellence and maintain superior customer service levels of the existing account/client**

	- Undertake product trainings to stay current with product features, changes and updates

	- Enroll in product specific and any other trainings per client requirements/recommendations

	- Partner with team leaders to brainstorm and identify training themes and learning issues to better serve the client

	- Update job knowledge by participating in self learning opportunities and maintaining personal networks

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Deliver

		No
		Performance Parameter
		Measure

		1
		Process
		No. of cases resolved per day, compliance to process and quality standards, meeting process level SLAs, Pulse score, Customer feedback

		2
		Self- Management
		Productivity, efficiency, absenteeism, Training Hours, No of technical training completed