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:

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):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource’s national leadership in quality and operational excellence. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi.

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.