Registered Nurse II

Duties:
No direct patientcare. This is a virtual(Remote) position.
Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers. This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc. The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial. Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients. The system leveraged for this coding is a web-based platform proprietary to Client, and selected contractor will be trained on how to leverage this platform. Additionally, the individuals should have strong skills with Microsoft office, particularly Excel.
Configuration support will be for both pharmacy and medical criteria and will require good creative problem solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency.
Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal Client business partners. An individual with strong and effective communication skills is highly desired.
Requires RN license.
3 Non-Negotiable Skills:
- Licensed RN
- Good communication
- Attention to detail

Education:
Requires RN license.

Skills:
Communication, Microsoft Office, Organization, Self-Driven, Collaboration Qualifications:(1) Demonstrates 'Team Player' and collaborative skills within internal and external teams(2) Takes risks by thinking strategically about problems and challenges within their domain(3) Communicates effectively within peer group and subordinate groups(4) Holds oneself accountable for designated client relationships and the delivery of requests associated to service.(5) Capable of & develops robust operational controls to maximize service levels.(6) Able to identify the needs of clinical system or process changes to help enhance service levels.(7) Ability to comprehend and articulate the importance of assigned responsibilities and controls.(8) Able to mitigate concerns of business partners within direct Product of responsibility.(9) Able to clearly communicate directly with clients when providing consultative services.

City: Morris Plains

Schedule:
Start Date: 05/04/2026
End Date: 12/31/2026
Schedule Notes: 9a-5:30pm EST M-F (30 min unpaid lunch) 100% Remote
Hours Per Week: 40.00
Hours Per Day: 8.00
Days Per Week: 5.00