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LPN/LVN - Prior Authorization

ICONMA

Role overview

Qualifications

  • Active unrestricted LPN/LVN license
  • Minimum 6 months prior authorization experience; Prior appeals experience is preferred
  • PBM, specialty pharmacy, payer, or medical office (MDO) experience
  • Experience using CoverMyMeds or similar authorization platforms

Responsibilities

  • Provide processing and communication of Commercial Prior Authorizations (PA) and Appeals
  • Oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies, and members
  • Maintain complete and accurate documentation of all necessary information
  • Train and mentor representatives on the PA/Appeals team

Key facts

Hard skills

Other skills

  • Communication
  • Problem Solving
  • Teamwork
  • Time Management

About the company

ICONMA logo

ICONMA

Management Consulting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge
IndustryManagement Consulting
Company size1001 - 5000

Links

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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:
  • 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
 
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Marcus Rivera

Chief Revenue Officer

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linkedin.com/in/marcusrivera
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