Pharmaceutical Support Nurse

This is a fully remote position, open to applicants in California.

📋 Description

• Deliver telephonic assistance to healthcare providers and patients for pharmaceutical contracts funded by clients.

• Evaluate payer-specific coverage criteria, prior authorization requests, and appeals submissions.

• Utilize client-approved program resources for written communication.

• Establish and nurture robust customer relationships that facilitate patient access activities.

• Comply with program-specific contractual agreements and company policies.

• Exhibit clinical expertise in reimbursement processes, products, and medical record management.

• Review and mentor team members on reimbursement, product knowledge, and medical record concepts.

• Resolve complex cases, identify trends in disease states, analyze data, and address escalated reimbursement challenges.

• Assess payer product coverage criteria and denial letters to ensure all documentation needed for coverage decisions is complete.

• Liaise with healthcare providers to discuss payer coverage criteria and any missing submission information.

• Manage both inbound and outbound inquiries, collect data, and document follow-up calls, patient inquiries, outcomes, clinical notes, and medical record/chart reviews.

• Collect, analyze, and compile data for Quarterly Business Reviews and client meetings.

• Participate in program-specific customer meetings and training sessions.

• Report patient Adverse Drug Events in accordance with manufacturer guidelines.

• Attend manufacturer conferences, customer meetings/training, and QBRs, which may involve requested in-person travel.

• Complete special projects and other assigned responsibilities.

⛳️ Requirements

• An associate degree and a professional nursing license are required.

• Must hold a Registered Nurse License in good standing in the state of employment.

• A Compact State License is necessary for eligible-state telephonic clinical roles, with a willingness to obtain it when needed.

• California State License is required for telephonic clinical positions.

• Must be willing to acquire additional single-state licenses if requested.

• Previous experience in the PBM or healthcare sector is essential.

• Proficient in researching, analyzing, preparing reports, and documenting thoroughly.

• At least 2 years of experience in a customer service role, preferably within a call center environment.

• Proficient in Microsoft Office applications, particularly Excel.

• Capable of thriving in a fast-paced environment and managing multiple tasks simultaneously.

• Strong written and verbal communication abilities.

• Advanced problem-solving and troubleshooting capabilities, along with critical thinking skills.

• High attention to detail and strong relationship-building skills.

• Ability to train fellow team members effectively.

• Comfortable spending most of the workday on the phone in both inbound/outbound queues and virtual calls.

• Capable of remaining at a workstation throughout the workday.

• Availability for shifts scheduled between 8:00 AM and 9:00 PM ET.

• Willingness to work a rotating Saturday shift approximately every 5 weeks and select rotating holidays.

• Must be available to start on Tuesday, September 8, 2026.

• No scheduled time off is permitted during the 7-week training program.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement available after 90 days of employment.

• Flexible working environment.

• 20 days of paid time off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision insurance.

• Health Savings Account (HSA) and Flexible Spending Account (FSA).

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance support.

• Short-term disability benefits after 90 days of employment.

• Long-term disability coverage.

• Life insurance options.

• Discount programs available.

• Saturday hours compensated as overtime.