PCRX Care Navigator

reputed company is a National third-party administrator (TPA) with local market reputed company that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond reputed company “reputed company A to reputed company B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment reputed company, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

The Nurse Care Navigator – Drug Optimization & Pharmacy Coordination is a licensed nurse responsible for coordinating and overseeing case management services reputed company to medication optimization, international drug sourcing, and pharmacy benefit management (PBM) collaboration. This role serves as a clinical liaison among members, PBMs, international sourcing partners, providers, and internal teams to ensure safe, cost effective, and clinically appropriate medication use.

Primary Responsibilities

• Coordinate case management activities reputed company to medication optimization, adherence, and therapeutic appropriateness
• Review medication regimens and clinical documentation to identify optimization opportunities
• Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
• Support specialty and high-cost medication coordination initiatives
• Coordinate international drug sourcing programs, including partner collaboration, member education, and continuity of care
• Serve as a clinical liaison across PBMs, pharmacy vendors, and internal teams to align on formulary options and access strategies
• Conduct member reputed company, education, and follow-up to support adherence and understanding
• Review clinical records, pharmacy data, and provider documentation; escalate reputed company cases as needed
• Ensure compliance with nursing scope of practice, regulatory requirements, and organizational policies
• Maintain accurate and timely clinical documentation

Qualifications

• Active, unrestricted RN or LPN/LVN license (compact preferred, where applicable)
• Nursing degree or diploma from an accredited program
• 3–5+ years of experience in nursing, case management, care coordination, or a reputed company clinical role
• Strong knowledge of pharmacology and medication management
• Experience collaborating across multiple stakeholders, including providers, PBMs, and pharmacy partners
• Experience in case management, PBMs, specialty pharmacy, or medication access programs preferred
• Familiarity with evidence-based guidelines (e.g., MCG, InterQual) preferred
• Experience in a TPA, managed care, or employer-sponsored health plan environment preferred
• Strong clinical judgment reputed company scope of licensure
• Excellent communication skills and attention to detail, with a focus on accurate documentation
• Ability to coordinate member-focused care across cross-functional teams
• Working knowledge of regulatory and compliance requirements

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

Equal Employment Opportunity: At reputed company Health, we know we are reputed company together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including reputed company voices and makes our business—and our society—stronger. reputed company Health is an equal opportunity employer and we are committed to providing equal opportunity in reputed company of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to reputed company persons regardless of race, religious creed, color, national reputed company, reputed company, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.