Description Location: This position is located at our Dublin, OH campus with hybrid flexibility. Multistate Licensure: Quantum Health nurses must be willing and able to obtain and maintain nursing licensure in multiple states, as required by the business. All application and filing fees will be paid by Quantum Health. We're on a mission to make healthcare simpler and more effective. We fight to ensure our members get the care they need, when they need it, at the most affordable cost - that's why we call ourselves Healthcare Warriors. We're committed to building diverse and inclusive teams, so if you're excited about this position, we encourage you to apply - even if your experience doesn't match every requirement. The Pre-Certification Review Nurse - Pharmacy is responsible for reviewing and processing coverage determinations and utilization management reviews for specialty medications, to include site of care assessments, for enrollees of Quantum Health's employer groups. The nurse is responsible for acquiring all clinical documentation to appropriately process the service request within the designated time frames indicated. What you'll do Review and process all requests for specialty medications and site of care assessment/transitions. Maintain a working knowledge of all clinical processes and workflows, as well as all employer benefit plans and how to access needed information. Work with Medical Director/Physician reviewer and Pharmacy Services team for all requests requiringphysician review. May serve as a Subject Matter Expert (SME) for a clinical process or content area. Communicate with member, provider, facility and all internal work groups regarding outcome of requests. Identification of members who may be appropriate for case management services (Complex, High cost, Transplant) Identify care coordination opportunities and work with clinical teams on as needed basis. All other duties as assigned. What you'll bring Education / Licensure: Active license in good standing as aRegistered Nurse(RN) in the state of Ohio required. Licensed Practical Nurses (LPNs) currently employed by Quantum Health may also be considered. Minimum of 2 years of direct care nursing experience Ability to obtainadditional licenses, as needed (with support from Quantum Health) Strong working knowledge of Network Medical guidelines Experience with Specialty Pharmacy/Pharmaceuticals preferred Makes clinical decisions quickly and at times decides and acts with limited information Excellent critical thinking skills Strong interpersonal skills Excellent verbal and written communication skills Self-directed, organized with excellent time management skills Excellent computer skills including Microsoft applications Protect and take care of our company and member's data every day by committing to work within our company ethics and policies Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently. Trustworthy and accountable behavior, capable of viewing andmaintaining confidential information daily. What's in it for you Compensation: Competitive base pay, incentive plans and employee referral bonuses. Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoptionassistance, EAP, Teladoc services and more. Retirement: 401(k) plan with up to 4% employer match and full vesting on day one. Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more. Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development. Cul