Utilization Management Nurse - LPN or RN - Full-time / Part-time

We are currently looking to hire and LPN or RN at a growing health care company in the Twin Cities.

This position on the Medical Drug Review team will assess coverage determinations (prior authorization requests) for specialty medications that are covered under medical benefits. This individual will be responsible for the clinical criteria review, documentation, case management and coverage recommendation for specialty medications requiring criteria review.

* Process, communicate, document and complete reviews for coverage within the required turnaround time

* Validate member eligibility for coverage (in both pharmacy and medical claims systems), select correct criteria and ensure all needed member and clinical information has been received to effectively complete the coverage review

* If criteria is met provide proper notification to the health plan, specialty pharmacy, prescribing doctor and member. If criteria is not met, forward all pertinent case information onto designated physician for review

* Responsible for handling pharmacy and physician calls related to the clinical criteria review process, occasional member assistance

* Responsible for entering approval records (e.g., prior authorization overrides) at the drug-specific level to ensure the appropriate claims will adjudicate

* Assist with special projects as needed. Including but not limited to, maintenance of systems and criteria, trending, system QA for new releases, delegation audit support

Hours: 8am-4:30pm or 8:30am-5pm (Full Time)

Environment: Coporate/Business Casual

Rate for LPN: $19 - $22

Rate for RN: $30 -$35

About Aerotek: Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit aerotek.com. Aerotek is acting as an Employment Agency in relation to this vacancy.