209314
Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.
Summary: The Nursing Care Coordinator within the Pharmacy Department’s Medication Assistance Program (MAP) collaborates closely with pharmacy staff, clinic teams, and providers to obtain necessary clinical information to meet insurance requirements and manage prescription medication appeals for the MAP Pharmacy Benefit service line. This role also ensures that patients and clinicians receive accurate, timely, and up-to-date information. The Nursing Care Coordinator reports directly to the Clinical Manager of Medication Assistance Program Pharmacy Benefit Services.
Responsibilities:
The primary responsibility of this role is to manage prescription medication insurance appeals for the MAP Pharmacy Benefit service line and serve as a clinical resource to MAP specialists during benefits investigations and assessments of medication assistance needs. Additional responsibilities include care coordination, data analysis and performance tracking, and education.
- Assess patients within specialized populations to identify and coordinate ongoing care needs related to medication access. Utilize clinical expertise to support patient care and act as a liaison between patients, families, and the healthcare team regarding insurance requirements and medication assistance.
- Support and optimize the use of AI tools to enhance the efficiency and accuracy of the appeals process.
- Collaborate with the healthcare team to provide clinical insight, information, and resources that facilitate appropriate patient care and access to medications.
- Collect and manage data related to specialized patient populations, ensuring accurate entry into databases and registries for reporting and benchmarking purposes.
-
- Maintain professional development by engaging in continuing education, including conferences, presentations, and review of current literature. Demonstrate and model professional nursing practice through consistent professional behaviors.
Other Information
Other information:
Education Requirements:
● Graduation from a state-accredited school of professional nursing
Licensure/Certification Requirements:
● Licensed to practice as a Registered Nurse in the state of North Carolina.
Professional Experience Requirements:
● Five (5) years of professional nursing experience.
Knowledge/Skills/and Abilities Requirements:
Job Details
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Amb. Pharm Care Network – MAP
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $35.87 – $51.57 per hour (Hiring Range)
Pay offers are determined by experience and internal equity
Work Assignment Type: Remote
Work Schedule: Day Job
Location of Job: US:NC:Durham
Exempt From Overtime: Exempt: Yes
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants’ and employees’ religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.
