Pre-Cert Pharmacy Review Nurse, RN – Pharmacy Experience Required

Quantum Health

Pre-Certification Review Nurse responsible for overseeing specialty medication requests. Collaborating with clinical teams to ensure appropriate utilization management decisions.

Posted 5/20/2026full-timeRemote • Ohio • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Clinically review all requests for provider-administered specialty medications for appropriateness
Support providers and members in optimization of site of care for requested services
Demonstrate and expand a working knowledge of all clinical processes and medical policy
Work collaboratively with Medical Directors and Pharmacists for all relevant requests
Serve as a Subject Matter Expert (SME) for infusible and injectable medication-related services
Communicate with members, providers, facilities, and all internal work groups regarding outcome of requests
Identify members who may be appropriate for care/case management services
Identify care coordination opportunities and work with operational, clinical, and customer-facing teams

Requirements

What you’ll need

Bachelor’s degree in nursing or closely related field or equivalent experience
Current and active and unrestricted license as a Registered Nurse (RN) in the state of Ohio
Minimum of 2 years of managed care and/or direct care nursing experience required
Experience with Specialty Pharmacy/Pharmaceuticals required
Experience with Utilization Management required
Makes clinical decisions quickly and at times decides and acts with limited information
Excellent critical thinking skills
Strong interpersonal, verbal and written communication skills
Self-directed, organized with excellent time management skills
Excellent computer skills including Microsoft applications
Strong administrative/technical skills

Benefits

Comp & perks

Health, vision and dental insurance
Life insurance
Legal and identity protection
Adoption assistance
EAP and Teladoc services
401(k) plan with up to 4% employer match and full vesting on day one
Paid Time Off (PTO)
7 paid holidays
Parental leave
Volunteer days
Paid sabbaticals
Tuition reimbursement up to $5,250 annually
Certification/continuing education reimbursement
Discounted higher education partnerships
Paid trainings and leadership development
Recognition as a Best Place to Work for 15+ years
Modern workplace with a casual dress code

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical reviewmanaged care nursingdirect care nursingspecialty pharmacyutilization managementcare coordinationcase managementcritical thinkingadministrative skillstechnical skills

Soft Skills

interpersonal skillsverbal communicationwritten communicationself-directedorganizedtime management

Certifications

Registered Nurse (RN) license