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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical assessment, medication evaluation, and case management while ensuring adherence to ethical, legal, and regulatory standards. Proficient in negotiating care levels and communicating effectively with healthcare providers and clients.
Highest-signal resume keywords
Active RN LicenseClinical AssessmentCase Management CertificationDrug Utilization ReviewPatient Safety Advocacy
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medication EvaluationClinical CarePharmacy Reports AnalysisAlternative Treatment RecommendationsDrug Diversion Testing
Soft Skills
Effective CommunicationNegotiation SkillsClient Advocacy
Tools & Technologies
Pharmacy Benefit Manager
Certifications & Qualifications
Case Management CertificationPharmacy CertificationRehabilitation Nursing Certification
Industry Keywords
Patient SafetyQuality Assurance StandardsEthical StandardsRegulatory StandardsCultural Implications
About the role
Key responsibilities & impact- To utilize evidence based tools to evaluate the prescribed medications to ensure patient safety and quality standards are in alignment with best practice standards.
- Performs clinical assessment via information in pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place.
- Evaluates patient drug usage and physician prescribing patterns.
- Evaluates overuse, underuse and misuse of prescribed medications and may recommend testing to determine if drug diversion is present.
- Evaluates need for and recommends alternative treatment.
- Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary.
- Negotiates appropriate level and intensity of care through use of medical and disability duration guidelines, adhering to quality assurance standards.
- Negotiates changes in pharmacy plan with providers.
- Acts as a resource in consulting with the client, nursing staff and claims examiners regarding pharmacy issues.
- Performs drug utilization reviews through the pharmacy benefit manager or vendor.
- Communicates effectively with claims examiner, client, vendor, supervisor and other parties as needed.
- Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
Requirements
What you’ll need- Active unrestricted RN license in a state or territory of the United States required.
- Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred.
- Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
- Four (4) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management.
Benefits
Comp & perks- Health insurance
- Dental insurance
- Vision insurance
- 401(k)
- Paid time off
