Job description

Our client, a Retail Pharmacy company, is looking for a Licensed Vocational Nurse for their Remote location.

Responsibilities:

Provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Caremark Specialty Medical Prior Authorization department.
Reporting to the Pharmacy Operations Manager, you will work with physician office staff and customer service, admissions and pharmacy operations departments to communicate prior authorization status.
Oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies and members based on program criteria.
Answering inbound phone calls, processing cases and electronic authorizations, loading authorizations, and making follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards.
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.
Registered Nurses (RNs) not accepted for LVN/LPN
Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards.
Sort incoming faxes in compliance with departmental and client requirements.
Manage case load of for all clients by researching and triaging incoming fax requests.
Use eligibility systems to identify the type of request and create, route, and/or complete appeals or requests in accordance with department processes.
Process External Review appeal requests according to federal, client, and state mandated guidelines.
Act as a subject matter expert and assists with Coordinator duties dependent upon business needs.
Provides support/mentoring to Coordinator staff to solve case processing questions and issues.
Collaborate with Pharmacy Technicians, Pharmacists, and other internal partners for timely resolution of issues with case processing.
Works closely with internal partners to develop work instructions and promote process improvements.
Other duties assigned

Requirements:

Verifyable High School Diploma or GED Required
Experience: 1-3 years experience

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities

Licensed Vocational Nurse

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