Duration: 12 Months
Job Summary:
This is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA compliant work area away from distractions, and must have their own secure private internet services of at least 25mbps download/3mbps upload in order to ensure sufficient speed to adequately perform work duties. Must provide a screenshot of internet speeds with resume and provide license number.
Responsibilities:
Responsibilities include 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.
Experience:
· ∙ 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.
Education:
The Licensed Practical Nurse is a graduate of a school of Practical or Vocational Nursing, approved by the State Agency and/or accredited by the National League for Nursing (Accrediting Commission (NLNAC)) at the time the program was completed by the applicant.
Skills:
LPN, Prior auth
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