Communications Nurse (LPN) - Fully Remote
JX22004061424 - Licensed Practical Nurse - Remote Providence, Rhode Island (Remote)
2 Years
Contract (12 Months)
Pay Rate USD 27 hourly
The Licensed Practical Nurse (LPN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy 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.
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
Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations
Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment
This position involves sedentary work with periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer
Position requires proficiency with computer skills which include navigating multiple systems and keyboarding
Excellent communication skills, both written and verbal
Must have regular and predictable attendance
Minimum 2 years clinical experience as a LPN/LVN
Prior authorization experience or Case Management experience
A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states
3+ years prior related clinical work experience
Experience using MS Office and other Windows-based computer applications and phone use
Digital charting
Managed care or health plan previous experience
Call center experience
Multi-tasking experience
Prior remote experience
Case Management experience
Prior authorization experience
High production experience
#J-18808-Ljbffr Sonya M. Recruiting
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2 Years
Contract (12 Months)
Pay Rate USD 27 hourly
The Licensed Practical Nurse (LPN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy 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.
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
Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations
Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment
This position involves sedentary work with periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer
Position requires proficiency with computer skills which include navigating multiple systems and keyboarding
Excellent communication skills, both written and verbal
Must have regular and predictable attendance
Minimum 2 years clinical experience as a LPN/LVN
Prior authorization experience or Case Management experience
A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states
3+ years prior related clinical work experience
Experience using MS Office and other Windows-based computer applications and phone use
Digital charting
Managed care or health plan previous experience
Call center experience
Multi-tasking experience
Prior remote experience
Case Management experience
Prior authorization experience
High production experience
#J-18808-Ljbffr Sonya M. Recruiting
Apply tot his job
Apply To this Job