Registered Nurse, Rx Refill and Prior Authorization Specialist- Behavioral Health Navigation Center

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The position is hybrid between remote and Broadhead Rd.

The Registered Nurse, Rx Refill and Prior Authorization Specialist- Behavioral Health Navigation Center is responsible for successfully delivering an exceptional patient experience and ensuring patients receive proper prescription refill services. This role will work with the Rx Refill team as an escalation contact for medication refill work queues and medication prior authorization requests. The Registered Nurse, Rx Refill Specialist is responsible for responding to refill requests, following Behavioral Health Navigation Center and pharmacy procedures in refilling medications, and escalating medication concerns and controlled substances to practices and providers. This role will also perform mentoring and support to the team of Rx Refill Specialists.

JOB DUTIES AND RESPONSIBILITIES:

• Processes incoming phone and electronic patient medication refills and prior authorization requests using electronic health record, patient engagement tools and prescription refill platforms.

• Engages patients in a polite, prompt and compassionate manner during all patient interactions.

• Reviews medical records and specialty-specific prescription refill protocols to support filling of prescription when a refill request flags for review.

• Utilizes defined escalatory workflows to notify prescribing provider of medication requests that have not met protocol criteria.

• Facilitates correspondence with patients, providers, insurance companies and pharmacies as necessary to address medical refill requests.

• Monitors prior authorization work queues WQ(s) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure prior authorizations for medications, medical procedures, or testing.

• Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary.

• Seeks additional information and/or communicates updates to patients and providers as appropriate throughout the prior authorization process.

• Engages insurance company representatives and provides required clinical information to secure prior authorization, when necessary.

• Documents pertinent information in medical record and may notify patients of overdue visits and/or necessary screenings based on defined protocol.

• Escalates medication questions or concerns to leadership and/or designee as necessary.

• Collaboratively partners with other team members to promptly address patient requests and/or concerns that may originate in other settings (e.g., Behavioral Health Navigation Center, practice operations, etc.).

• Serves as a resource and Subject Matter Expert (SME) for other team members and internal customers, research complex issues, and works with support resources to resolve patient issues.

• Serves as an escalation point for clinical questions related to prescription refills and medication prior authorizations; completes escalated Rx refill and medication prior authorization requests.

• Collaborates with Behavioral Health Navigation Center to effectively plan, optimize staffing, flex daily staffing and monitor supply and demand to maintain service levels.

• Maintains good working relations with various practices to ensure an efficient Rx refill process.

• Helps maintain communication to the Behavioral Health Navigation Center related to medication refills, medication refill denials, medication related questions, and pharmacy communication.

• Analyzes current procedures, bringing suggestions for improvement to the attention of Sr. Director, Referral Development and Patient Access or appropriate leadership.

• Supports Rx Refill Specialists to follow medication refill protocols and external resources to verify if medications are appropriate to refill and informs providers of controlled substances refilling with multiple providers or locations.

• Other duties as assigned.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting for extended periods (up to 8 hours), continual finger use, writing, computer entry, ability to hear normal conversation, and good general near and peripheral vision are required.

EDUCATION:

Required: Graduate of an accredited nursing program. Active Registered Nurse licensure in the state of Pennsylvania. Bachelor’s degree in nursing preferred.

TRAINING AND EXPERIENCE:

Minimum three years recent clinical experience in a pharmacy or related office required. Familiarity/experience with patient interactions on the telephone required. Epic Cadence experience required. Minimum of two years of leadership or management experience preferred. Ability to work from home in accordance with the Network Work from Home Policy if needed.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.

About Us

Founded in 1872, St. Luke’s University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 23,000 employees providing services at 16 campuses and 350+ outpatient sites. With annual net revenue in excess of $4 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke’s Children’s Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare’s five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World’s Best Hospital. The Network’s flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Premier 13 times total and eleven years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY. In 2021, St. Luke’s was identified as one of the 15 Top Health Systems nationally.

St. Luke’s is the ONLY health care institution in the Lehigh Valley to be named a Top Workplace regionally repeating the exclusive honor for the third year in a row. Also, for the third straight year, St. Luke’s has been a Top Workplaces in the Philadelphia Region by the Philadelphia Inquirer, ranking 9th in the large employer category for 2025 and the only health care system in PA to receive this award. In 2025, St. Luke’s was recognized as a national Top Workplaces by USA Today, three years in a row, including the 3rd best health care system in the nation in 2023 and 2024. Lastly, in 2025, St. Luke’s was named a Top Workplace in New Jersey for the third year in a row.

Learn More Here.