Jx22004061424

Providence, Rhode Island (Remote)

2 Years

Contract (12 Months)

Pay Rate USD 27 hourly

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.

• Review criteria-based prior authorizations following policy and procedure
  · Provide on-call after hours nurse availability for urgent PA requests
  · 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.
  · Excellent verbal and written skills.
  · 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.
  · Train and mentor representatives on the PA team. 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
  
  * Minimum 2 years clinical experience as a LPN/LVN.
  * Prior authorization experience or Case Management experience
  * A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states.
  · 3+ years prior related clinical work experience
  · 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
  · Case Management experience
  · Prior authorization experience
  · High production experience
  

  Education: Bachelors Degree