Job Title: Prior Authorization Nurse (Remote, USA)
Position Summary: We are looking for a Licensed Practical Nurse (LPN) to manage the processing and communication of commercial prior authorizations for pharmacy benefits. This fully remote role involves collaboration with various departments to ensure efficient service delivery and adherence to policy guidelines.
Key Responsibilities
Process and communicate commercial prior authorizations as reviewed by the team.
Collaborate with physician office staff, customer service, admissions, and pharmacy operations to communicate referral statuses.
Manage fax processing and provide telephone assistance based on program criteria.
Handle inbound calls, process cases, load authorizations, and conduct follow-up calls.
Maintain accurate documentation involving data entry, data management, and reporting.
Review authorization requests following policy and procedure.
Provide on-call after-hours support for urgent PA requests.
Offer internal support to the PA team and member services department.
Refer cases not meeting clinical criteria to the Pharmacist and MD teams.
Train and mentor PA team representatives.
Utilize clinical skills to support documentation and communication of medical services.
Experience
Minimum of 2 years of clinical experience as an LPN/LVN.
Experience in prior authorization, case management, or related field.
Proficiency with MS Office, Windows-based applications, and phone systems.
Experience with digital charting, managed care, or health plan operations.
Call center and multi-tasking experience.
Previous remote work experience is a plus.
Education
Graduate of a Practical or Vocational Nursing program approved by the State Agency and/or accredited by the NLNAC.
Must possess a full, active, and unrestricted LPN/LVN license in the United States.
Work Schedule
Training: Monday to Friday, 8:00 AM - 4:30 PM CST.
Regular Hours: Monday to Friday, 8:00 AM - 8:00 PM CST.
Seniority level
Entry level
Employment type
Contract
Job function
Health Care Provider
Industries
Hospitals and Health Care
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