LVN/LPN (Remote Anywhere)

Position Title – Licensed Vocational Nurse
Address – Remote - Anywhere
Pay rate – 26/HR
Hours – Schedule:
For training there is a set schedule 8am-430pm CST Monday-Friday. Following training, they will have a permanent schedule. Shift range varies and is subject to change.
Shift range:
Sunday – Saturday 8:00 AM – 6:00 PM
Contract Type – Contract to possible hire
Vaccine Requirement – No

Required Skills & Education:
• Candidates MUST HAVE prior authorization experience in an MDO or a clinical setting. Please make sure this is clear on their resumes.
• 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.

Position Purpose:
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

Responsibilities:
• Review complex clinical criteria-based prior authorizations in accordance with the company's 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.