Offer summary
Qualifications:
LPN/LVN license in the state, 3-5 years work experience in LPN/LVN.Key responsabilities:
- Process medication prior authorizations
- Communicate referral status to departments
- Answer phone calls, make follow-ups
Match score not available
Priority access
Match score not available
Licensed Vocational Nurse
72% Flex
Remote:
Full Remote
Experience:
Mid-level (2-5 years)
Work from:
Rhode Island (USA)
Job description
Your missions
Location: Remote
Duration: 6 months
Description:
Candidates MUST HAVE prior authorization experience in an MDO or a clinical setting.
Provide processing and communication of Specialty medication prior authorization (PA) referrals reviewed by the Case Review Unit (CRU) for the Specialty Guideline Management Programs for the Pharmacy and Medical 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.
Verifiable High School Diploma or GED Required: Yes
Duties
Review complex clinical criteria-based prior authorizations in accordance with Client policies and procedures.
Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
Must possess excellent communication skills, both written and verbal.
Shift priorities while exhibiting a high level of urgency and responsiveness with all calls, prior authorization requests, and ADHOC assignments.
Follow all prior authorization procedures to meet business quality standards and ensuring the operational unit is complying with regulatory requirements and accreditation standards.
Participates in quality assurance activities on ongoing bases, including but not limited to reviewing work instructions and job aids regularly.
Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members.
Complete other prior authorization assignments as delegated by the leadership team.
Utilization of clinical and problem-solving skills to support the research of documentation, 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 extended periods of sitting, talking on the telephone, using multiple computer screens, and keyboarding.
Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding.
Must have regular and predictable attendance.
Colleague will be required to work business required overtime/ work weekends when business requires, making outreach, and processing prior authorization requests.
Experience
Hold and maintain an active LPN/LVN license in the state of practice.
Minimum 1 year experience reviewing and processing prior authorizations against health plan criteria for a determination in a clinical setting i.e. medical office or Pharmacy Benefits Manager (PBM)
Must have 3 to 5 years prior related work experience as an LPN/LVN in a medical office, PBM or clinical setting.
Experience using MS Office, other Windows-based computer applications, and phone use.
Position Summary
You will provide processing and communication of Specialty medication prior authorization (PA) referrals reviewed by the Case Review Unit (CRU) for the Specialty Guideline Management Programs for the Pharmacy and Medical 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
The Licensed Practical Nurse is a graduate of a school of Practical or Vocational Nursing, approved by the State Agency and/or accredited by the National League for Nursing (Accrediting Commission (NLNAC)) at the time the program was completed by the applicant.
The LPN/LVN must have a full, active and unrestricted license as a Licensed Practical or Vocational Nurse in a State, Territory or Commonwealth of the United States or District of Columbia.
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
Required profile
Experience
Level of experience: Mid-level (2-5 years)
Industry :
Human Resources, Staffing & Recruiting
Spoken language(s):
English
Check out the description to know which languages are mandatory. Soft Skills
- Excellent Communication
- Multitasking
- Teamwork
- Sense of Urgency
- Problem Solving
- Ability to Work in a Fast-Paced Environment
Share
Go Premium: Access the World's Largest Selection of Remote Jobs!
- Largest Inventory: Dive into the world's largest remote job inventory. More than half of these opportunities can't be found on standard platforms.
- Personalized Matches: Our AI-driven algorithms ensure you find job listings perfectly matched to your skills and preferences.
- Application fast-lane: Discover positions where you rank in the TOP 5% of applicants, and get personally introduced to recruiters with Jobgether.
- Try out our Premium Benefits with a 7-Day FREE TRIAL.
No obligations. Cancel anytime.