Licensed Vocational Nurse

Our client, a Retail Pharmacy company, is looking for a Licensed Vocational Nurse for their Remote location.

Responsibilities:

• Provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Caremark 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.
• Oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies and members based on program criteria.
• 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.
• Registered Nurses (RNs) not accepted for LVN/LPN
• Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards.
• Sort incoming faxes in compliance with departmental and client requirements.
• Manage case load of for all clients by researching and triaging incoming fax requests.
• Use eligibility systems to identify the type of request and create, route, and/or complete appeals or requests in accordance with department processes.
• Process External Review appeal requests according to federal, client, and state mandated guidelines.
• Act as a subject matter expert and assists with Coordinator duties dependent upon business needs.
• Provides support/mentoring to Coordinator staff to solve case processing questions and issues.
• Collaborate with Pharmacy Technicians, Pharmacists, and other internal partners for timely resolution of issues with case processing.
• Works closely with internal partners to develop work instructions and promote process improvements.
• Other duties assigned

Requirements:

• Verifyable High School Diploma or GED Required
• Experience: 1-3 years experience

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities