RN Reviewer, PDIP in Remote at Beacon Health Options

Date Posted: 6/29/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic RN REVIEWER, PDIP to join our team at our office in WOBURN, MA.  The PSYCHOTROPIC DRUG INTERVENTION PROGRAM (PDIP) is a unique, comprehensive, and integrated quality management program focused on identifying claims-based, medication-related problems including medication safety issues through the use of informatics, analytics, and clinical review. The program engages both prescribers and members, utilizing innovative technologies to achieve an understanding and resolution of medication related issues.

Position Responsibilities:

  • Weekly clinical review of medication-related problems in order to determine an appropriate intervention decision. Includes but not limited to reviewing polypharmacy, coordination of care and suboptimal dosing issues as well as potential non-adherence cases. When needed, escalate cases for medical review when appropriate.
  • Monthly clinical review of safety gaps in care and addiction management algorithm output. When needed, escalate cases for medical review when appropriate
  • Meet guidelines for established metrics of both quantity and quality performance.
  • Address and track all related questions and concerns of providers and/or members related to medication-related problems or other PDIP clinical initiatives
  • Assist in integration of PDIP process findings and history with other company departments such as care management.
  • Attend PDIP clinical meeting, for the purpose of group supervision and aligning practice within the department, expert discussion topics as needed with Beacon’s physician advisor or pharmacist(s).
  • Identify programmatic needs, identify and communicate patterns of concern, problem solving with technical teams as required.
  • Provide risk characterization analysis and provider/member review for the drugs of abuse program.
  • Participate in algorithm development and management with PDIP’s analytic department and clinical team.
  • Attend and present at PDIP internal and external meetings.
  • Assist PDIP’s analytic department with clinical perspective and data analysis including high-risk co-morbidities and treatment utilization drivers.
  • Coordinate quality testing process for new algorithm development, new client implementation and troubleshooting assessment.
  • Other duties as assigned.

Position Requirements:

Education: BSN Degree preferred

License(s):  RN

Relevant Work Experience:   A minimum 2 years’ experience in healthcare, behavioral health or human services. Reliable knowledge of MS Office, experience with electronic medical records.  

Knowledge, Skills & Abilities:

  • Knowledgeable of prevalent behavioral health diagnoses including addiction and associated comorbidities.
  • Knowledgeable of commonly prescribed medications used in behavioral health condition management.
  • Knowledgeable of common medication-related problems such as patient non-adherence, polypharmacy and suboptimal dose prescribing and the processes to manage then.
  • Understanding of managed care health insurance models.
  • Experience in developing process, monitoring documentation of procedures.
  • Strong analytical and problem solving abilities.
  • Interpersonal communication skills and includes both verbal and written.
  • Collaboration and team-oriented work philosophy.

TO APPLY

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Beacon Health Options company is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

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