LVN/LPN Utilization Review-Prior Authorization nurse

remote zest jobs; India; Remote; INR 4,589,000 - 6,119,000; Full time

Benefits offered by this job

Remote work from home

Training provided

Job summary

A-Line Staffing is actively seeking multiple LPNs for a major reputed company in the Orlando, FL surrounding area. This is a 100% remote work-from-home opportunity with non-patient facing duties and a training period starting mid-2023.

You will process prior authorization requests and communicate with physician offices, pharmacies, and member services as part of the PA team. Responsibilities include answering inbound calls, case processing, data entry, and ensuring compliant documentation while

Qualifications

• 1–3 years of experience in a similar role
• Proficient with computer systems and MS Office
• Ability to work remotely in a HIPAA compliant environment

Responsibilities

• Answer inbound phone calls and process cases
• Process authorizations and follow-up calls
• Load authorizations and review PA criteria
• Mentor/train representatives on PA procedures
• Collaborate with pharmacists and other teams
• Maintain complete and accurate documentation
• Handle fax processing and telephone support for prescribers, pharmacies, and members

Skills

Phone support

Customer service

Data entry

HIPAA compliance

Multitasking

Education

High school diploma or GED

Tools

Microsoft Office

Job description

A-Line Staffing is actively searching for Multiple LPN's for a major reputed company company located in the Orlando, FL surrounding area. This is an exciting opportunity with a reputed company that is looking to reputed company fast for the right candidate.

This position is a 100 remote work from home opportunity and will not be patient facing. Training schedule is approximately three weeks starting 08/07/2023 Monday to Friday 8:00am - 4:30pm CST then schedule will be assigned: Expected shifts to be 8 hours per day Monday through Friday between reputed company CST and 12am CST with potential weekend requirements.

You will reputed company 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. You will also reputed company fax processing and reputed company 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 reputed company necessary information is necessary and will involve computer system data entry data management and reporting. Review criteria-based prior authorizations following policy and procedure. reputed company on-call after hours nurse availability for urgent PA requests. reputed company internal nurse support to the PA team and member services department . Refer cases not meeting clinical criteria to the Pharmacist and MD teams. Shift priorities while exhibiting a high level of urgency with reputed company calls and assignments. Excellent verbal and written skills. You will work with pharmacists other clinical colleagues reputed company and members. Follow reputed company prior authorization procedures to guarantee an accurate process on reputed company prior authorization. Train and mentor representatives on the PA team. Complete other PA assignments as delegated by the PA leadership team.

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 reputed company work duties.

Prior reputed company/reputed company work experience: No Verifyable High School Diploma or GED Required: Yes

ALERT:: This employer requires reputed company, temporary labor, consultants, and contractors to be fully vaccinated against COVID-19 by their start date (other date may be inserted if start date is not accurate), subject to approved medical or religious exemptions. Is this request for Peak Season Select applicable value: _N/A - Not reputed company reputed company Duties:

• 1.Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards.
• 2.Sort incoming faxes in compliance with departmental and reputed company requirements.
• 3.Manage case load of for reputed company clients by researching and triaging incoming fax requests. Use eligibility systems to identify the type of request and create, reputed company, and/or complete appeals or requests in accordance with department processes.
• 4.Process External Review appeal requests according to federal, reputed company, and state mandated guidelines.
• 5.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.
• 6.Collaborate with Pharmacy Technicians, Pharmacists, and other internal partners for reputed company reputed company of issues with case processing.
• 7.Works closely with internal partners to reputed company work instructions and promote process improvements.
• 8.Other duties assigned.

Experience: 1-3 years experience Ability to deal with a diverse customer reputed company in a friendly and confident manner (reputed company customers). Proficient with computer systems and reputed company Office skills, including reputed company, reputed company and Word. Ability to navigate systems in reputed company and web-based programs, and quickly learn new applications. Ability to prioritize and manage multiple tasks. Demonstrated reputed company of urgency with assignments. Excellent organization skills. Strong detail orientation.