You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Client 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.
You will also oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies and members based on program criteria.
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.
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.
Verifyable High School Diploma or GED Required: Yes
Experience
Minimum of one year related work experience to include working with an electronic medical records in a high call volume environment.
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.
The LPN/LVN must have a full, active and unrestricted license as a Licensed Practical or Vocational Nurse in a State, Territory or Commonwealth of the United States or District of Columbia.
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
Employment type
Full-time
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