Prior Authorization LPN

Chemistry Rx is a compounding and specialty pharmacy dedicated to providing the highest quality of customized medication to patients, providers and other organizations across the entire healthcare continuum.

Our team of nurses, clinical pharmacists, and clinical care support work in synchrony with healthcare professionals, insurance companies and– most importantly– the patient.

We are seeking a Clinical Nurse ( LPN) to join our team!

Job Description:

Nurses perform various duties related to the Prior Authorization of prescription orders and specialty medical utilization management. The nurse will work closely with prescribers, patients and their families to develop sound and well-supported arguments that reflect the medical necessity of the prescription order. The nurse will also stay abreast of updates to treatment guidelines and of clinical publications that may impact the treatment landscape of various diseases, with a particular focus on rare disorders. The nurse will also be communicating with prescribers, patients and their families regarding prescription orders, the customization of compounded medications, and she/he will conduct extensive phone interviews with patients.

Primary Responsibilities:

Communicates with third-party payers and providers regarding initial and concurrent clinical review. Helps to support the appeal process to overturn insurance denials and/or benefit exclusions. Enters authorizations into the appropriate system to ensure accurate claims processing. Interacts with providers to gain additional clinical information regarding their prescription order. Performs initial and follow-up phone assessment of rare disease patients. Handles outbound and inbound calls to/from patients, office staff and prescribers. Provides clinical support to medication-related questions at Chemistry Rx. Assists with the establishment of clinical standards/processes. Ensures close coordination with pharmacists on patient clinical management. Represents the company in a professional manner and appearance at all times. Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual.

Professional Competencies:

Excellent written and verbal communication skills, effectively interacts with patients, co-workers, management and other healthcare professionals. Ability to exercise discretion and maintain confidentiality to level of required HIPAA standards.

Required Qualifications:

Working knowledge of current state and federal guidelines/regulations/laws. Knowledge of drug pharmacology, disease etiology and state-of-the-art management, with focus on rare disorders. Prior experience in pediatrics, the treatment/care of patients with conditions that require specialty medications and/or experience in ambulatory care setting with background in obtaining Prior Authorizations for medications. Strong customer service skills. Proficient in Microsoft Word and Excel. Highly motivated, very passionate about patient care and providing access to treatment options, and significant interest in working in several different disease areas at the same time.

Educational Requirements:

Completion of a Practical Nursing (diploma) program approved by the Commission on Collegiate Nursing Education (CCNE) or National League of Nursing Accrediting Commission (NLNAC).

At least 2-3 years of nursing experience.

Licensure and Certification Requirements: Full, current and unrestricted license as a Licensed Practical Nurse in the state of Pennsylvania.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Physical setting:

• Clinic

Standard shift:

• Day shift

Weekly schedule:

• Monday to Friday

Experience:

• Prior Authorization: 1 year (Required)
• Pediatrics: 1 year (Preferred)

License/Certification:

• LPN (Required)

Work Location: In person