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Posted 7 days ago
Requirements and responsibilities
Summary:
This position is a 100% remote, work from home in the USA opportunity and will not be patient facing. The Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits. This is a high production role with required metrics.
Work Schedule & Training Requirements:
- Work hours will vary between 8:00 AM – 8:00 PM Central Time (CT).
- Candidates must be able and willing to work Central Time hours, regardless of where they reside in the U.S.
Training:
- Training duration: 6 weeks.
- Training hours: 8:00 AM – 4:30 PM CT, Monday–Friday.
- Training attendance is mandatory and must be worked in full during these hours.
Overtime:
- Overtime is required based on business needs.
- Candidates must be flexible and able to work overtime when requested.
Duties:
- Review criteria-based prior authorizations following policy and procedure.
- Provide internal nurse support to the PA team and member services department.
- Refer cases not meeting clinical criteria to the Pharmacist and MD team(s).
- Shift priorities while exhibiting a high level of urgency with all calls and assignments.
- You will work with pharmacists, other clinical colleagues, healthcare professionals, and members.
- Follow all prior authorization procedures to guarantee an accurate process on each prior authorization.
- Complete other PA assignments as delegated by the PA leadership team.
- Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations.
- Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment.
- This position involves sedentary work with periods of sitting, talking, and listening.
- Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
- Position requires proficiency with computer skills which include navigating multiple systems and keyboarding.
- Excellent communication skills, both written and verbal.
- Must have regular and predictable attendance.
- Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve calls with a one-call solution.
- Performs other related projects and duties as assigned, including attending training sessions and development meetings.
Experience:
- Minimum 2 years clinical experience as an LPN/LVN.
- An LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license.
- Prior authorization experience or Case Management experience.
- 3+ years prior related clinical work experience.
- Ability to prioritize, quickly assess, manage multiple tasks, and adapt to constantly changing situations.
- Experience using MS Office and other Windows-based computer applications and phone use.
- Digital charting.
- Managed care or health plan previous experience.
- Call center experience.
- Multi-tasking experience.
- Prior remote experience preferred.
- Case Management experience.
- Prior authorization experience.
- High production experience.
- Excellent organizational skills.
- Strong detail orientation.
Position Summary:
- The Licensed Practical Nurse (LPN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits.
- Reporting to the Pharmacy Operations Manager, working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status.
- You will also oversee fax processing and providing telephone call assistance for prescriber office staff, pharmacies, and members based on program criteria.
- Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and making follow-up phone calls.
- Maintaining complete and accurate documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.
Education:
- Minimum 2 years clinical experience as an LPN/LVN.
- An LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license.
Work Schedule:
- Work hours vary from 8:00 AM to 8:00 PM CST.
- Training hours 8:00 AM - 4:30 PM CT.
- Mandatory overtime.
Optionally, you can add more information later (benefits, pre-screening questions, etc.)