Prior Authorization Nurse

Remote Prior Authorization Nurse

Overview: This is a remote position requiring a HIPAA-compliant work area. You'll play a crucial role in the Specialty Medical Prior Authorization department, processing and communicating specialty medication prior authorization requests. Reporting to the Pharmacy Operations Manager, you'll collaborate with various departments, ensuring prior authorization status is effectively communicated.

Responsibilities

• Review and process criteria-based prior authorizations per established policies.
• Provide on-call after-hours nurse availability for urgent PA requests.
• Offer internal nurse support to the PA team and member services.
• Refer cases not meeting clinical criteria to the Pharmacist and MD team(s).
• Maintain accurate documentation through computer system data entry.
• Answer inbound calls, process cases, and manage electronic authorizations.
• Conduct follow-up calls with professional and courteous behavior.
• Shift priorities with a high level of urgency for calls and assignments.
• Collaborate with pharmacists, clinical colleagues, healthcare professionals, and members.
• Follow all prior authorization procedures to ensure accuracy in the process.
• Train and mentor representatives on the PA team.
• Complete other PA assignments as delegated by the PA leadership team.
  
  

Requirements

• Licensed Practical Nurse or Licensed Vocational Nurse with an unrestricted license in the state of residence.
• Minimum 2 years of LPN/LVN clinical experience.
• Proficient in Microsoft Teams, Word, Excel, and Outlook.
• Diploma or Certification from an approved LPN/LVN program.
  
  

If you're a dynamic LPN/LVN seeking a remote opportunity to contribute to specialty medication prior authorizations, apply now to join our team.