IL
Licensed Vocational Nurse
ICONMA, LLC
🇺🇸 United States
Remote
5 days ago
$16 – $26 / hour
- prior authorization
- LPN
5 days ago
Not enough detail in this posting to match
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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 · ICONMA, LLC