CADENCE RX
Not just another PBM
Founded in early 2019, Cadence Rx launched an industry-leading peer-to-peer prescription platform created to elevate our clients experience within the workers compensation market. These goals are achieved through agile responsiveness, advanced technology, and true transparency. Cadence Rx, Inc. is a privately held business based in Tampa, Florida. We are a nationally recognized woman-owned business exclusively serving the national workers compensation market. Cadence Rx is an agile and entrepreneurial enterprise led by a dedicated team of industry professionals who share extensive workers compensation knowledge, pharmacy expertise, and experience in offering a high-touch customer service model.
Cadence Rx is looking for Clinical Reviewers to join our diverse teams to make innovation possible.
Position Summary:
The Cadence Rx Clinical Reviewer performs the review of New York State (NYS) Level 1 Medication Prior Authorization Requests (PAR) and submits coverage determinations into the New York State Workers Compensation Board (WCB) OnBoard Medical Portal in accordance with NYS workers compensation formulary regulations and procedures.
Roles and Responsibilities:- Make clinical determinations to approve or deny medication prior authorization requests based on evidence-based guidelines
- Evaluation of medical necessity and appropriateness of care
- Work in designated queues to complete business-related tasks
- Assign all new incoming level 1 PAR requests to the team
- Assist with adding medical decisions in the client portal
- Act as Workload Administrator in the NY State Workers Compensation Board (WCB)
- Enter all Medical Determinations within 4 days in the OnBoard Medical Portal
- Adhere to the NYS workers compensation formulary regulations and procedures
- Consistently meet required metrics while maintaining quality standards
- Adhere to all policies and procedures
- Other duties as assigned
Qualifications: - Active and unrestricted Philippine Nursing license with strong clinical assessment skills
- 2 years of experience with Utilization Review Processes or Case Management
- Experience in Workers Compensation is preferred
- Knowledge of HIPAA principles and standards
- Proficiency in Microsoft suite of products specifically Word, Excel and Outlook preferred
- Exposure to Microsoft Dynamics 365 is an advantage
- Must have excellent organizational, communication and customer service skills
- Keen attention to detail
- Work as a team player in conjunction with all areas of the organization
- Demonstrates initiative to proactively solve issues with minimal supervision
- Typing speed of > 45 words per minute preferred
- Willing to work any assigned shift during a work week in Makati City
