Licensed Vocational Nurse/Licensed practical Nurse - PA
Position type : Full time
Location: Fully remote
Onsite Flexibility: All Remote
Pay range : ($34.00 - $37.16)
Job Description:
Candidates MUST HAVE prior authorization experience in an MDO or a clinical setting. Please make sure this is clear on their resumes.
This position is a 100% remote, work from home opportunity and will not be patient facing.
Provide processing and communication of Specialty medication prior authorization (PA) referrals reviewed by the Case Review Unit (CRU) for the Specialty Guideline Management Programs for the Pharmacy and Medical 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.
Duties:
Review complex clinical criteria-based prior authorizations in accordance with CVS/Caremark policies and procedures.
∙ Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
∙ Must possess excellent communication skills, both written and verbal.
∙ Shift priorities while exhibiting a high level of urgency and responsiveness with all calls, prior authorization requests, and ADHOC assignments.
∙ Follow all prior authorization procedures to meet business quality standards and ensuring the operational unit is complying with regulatory requirements and accreditation standards.
∙ Participates in quality assurance activities on ongoing bases, including but not limited to reviewing work instructions and job aids regularly.
Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members.
∙ Complete other prior authorization assignments as delegated by the leadership team.
∙ Working hours will vary. Shift range include Sunday – Saturday 8:00 AM – 6:00 PM CST.
∙ Utilization of clinical and problem-solving skills to support the research of documentation, 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 extended periods of sitting, talking on the telephone, using multiple computer screens, and keyboarding.
∙ Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding.
∙ Must have regular and predictable attendance.
∙ Colleague will be required to work business required overtime/ work weekends when business requires, making outreach, and processing prior authorization requests.
Experience:
Hold and maintain an active RN /Registered Nurse license in the state of practice.
Minimum 1 year experience reviewing and processing prior authorizations against health plan criteria for a determination in a clinical setting i.e. medical office or Pharmacy Benefits Manager (PBM)
Must have 3 to 5 years prior related work experience as an LPN/LVN in a medical office, PBM or clinical setting.
Experience using MS Office, other Windows-based computer applications, and phone use.
Position 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.
Education
RN unrestricted license
Schedule:
For training there is a set schedule 8am-430pm CST Monday-Friday. Following training, they will have a permanent schedule. Shift range varies and is subject to change.
Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
About LanceSoft
LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.
EEO Employer
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
Want to read more about LanceSoft?
Click here to visit our website - www.lancesoft.com
Employment type
Full-time
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