Job Description:
This is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA compliant work area away from distractions, and must have their own secure private internet services of at least 25mbps download/3mbps upload in order to ensure sufficient speed to adequately perform work duties. Must provide a screenshot of internet speeds with resume and provide license number.
Responsibilities:
- 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.
- 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.
Experience:
Minimum of one year related work experience to include working with an electronic medical records in a high call volume environment.
Skills:
- Prior Authorization
- Call handling experience.
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.
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit
www.ustechsolutions.com.
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
