Job Description
Our Client, a Retail Pharmacy, is looking for a Prior Authorization Licensed Vocational Nurse (LPN/LVN) to work remotely within the United States.
Responsibilities:
Requirements:
Why Should You Apply?
#mcb
#alljobs
Responsibilities:
- Provide processing and communication of Commercial Prior Authorizations (PA) and Appeals reviewed by the Commercial PA and Appeals team for Pharmacy benefits.
- 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 determinations, 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/appeals following policy and procedure
- Provide internal nurse support to the PA/Appeals 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.
- Follow all prior authorization and appeals procedures to guarantee an accurate process on each prior authorization.
- Train and mentor representatives on the PA/Appeals team. Complete other PA/Appeals assignments as delegated by the PA/Appeals leadership team.
- Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations
Requirements:
- Active unrestricted LPN/LVN license
- Minimum 6 months[s] [/s]prior authorization experience; Prior appeals experience is preferred
- PBM, specialty pharmacy, payer, or medical office (MDO) experience
- Experience reviewing and applying clinical criteria and supporting documentation for PAs
- Experience using CoverMyMeds or similar authorization platforms
- Familiarity with chart notes, claims history, and insurance requirements
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
#mcb
#alljobs
Numbers & Facts
| Location | Remote, RI (Remote) |
| Industry | Management Consulting Services |
| Salary | $16–$26 Per Hour |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | https://www.iconma.com/ |
Benefits
401K, Employee Referral Program, Life Insurance
About Company
ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.
- Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
- Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
- Founded in 2000
- 2000+ Employees
The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.
Skills
Level up your application
Professional resume templates
Browse dozens of recruiter approved resume templates, layouts and formats. Choose your favorite and make it your own in minutes.
Free resume templatesResume Builder
Improve your existing resume or start from scratch and create a standout, ATS-friendly resume. Add job-specific content, download and apply.
Resume Builder