Job Description
Job ID: 26-118404
Position Type: Remote
Location: Remote
Work Type: Fulltime
Est. Pay Range: $26.00/hr. To $28.50/hr. All-inclusive on W2
Position Summary:
Duties:
Experience:
Education:
Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
Position Type: Remote
Location: Remote
Work Type: Fulltime
Est. Pay Range: $26.00/hr. To $28.50/hr. All-inclusive on W2
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.
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, 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:
- At least 1-3 years recent Prior Authorization experience.
- Pharmacy benefit PA preferred.
- Experience working within payer, health plan, PBM, utilization management, or managed care environments.
- Experience handling production metrics. Simultaneous phone, documentation, and authorization processing.
- Minimum 2 years clinical experience as a LPN/LVN.
- A 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.
Education:
- A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license.
Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
Numbers & Facts
| Location | Please note: Actual location may vary., RI (Remote) |
| Industry | Staffing/Employment Agencies |
| Salary | $26 |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | http://www.lancesoft.com/ |
About Company
We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc).
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.
Skills
- Call Centersunmatched
- Case Managementunmatched
- Clinical Competencyunmatched
- Clinical Supportunmatched
- Communication Skillsunmatched
- Computer Skillsunmatched
- Computer Systemsunmatched
- Customer Support/Serviceunmatched
- Data Entryunmatched
- Data Managementunmatched
- Detail Orientedunmatched
- Documentationunmatched
- Establish Prioritiesunmatched
- Health Planunmatched
- Healthcareunmatched
- Healthcare Providersunmatched
- Leadershipunmatched
- Licensed Practical Nurse/Licensed Vocational Nurseunmatched
- Managed Careunmatched
- Medical Officeunmatched
- Metricsunmatched
- Microsoft Officeunmatched
- Microsoft Windows Operating Systemunmatched
- Multitaskingunmatched
- Nursingunmatched
- Operational Communicationsunmatched
- Operations Managementunmatched
- Organizational Skillsunmatched
- Patient Care Authorizationsunmatched
- Pharmacyunmatched
- Presentation/Verbal Skillsunmatched
- Support Documentationunmatched
- Telephone Skillsunmatched
- Typingunmatched
- Utilization Managementunmatched
- Writing Skillsunmatched
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