Licensed Vocational Nurse

Lensa; United States; Remote; USD 72,000 - 95,000; Full time

Job summary

A leading healthcare provider is seeking a Utilization Management Nurse to work from home, focusing on processing specialty medication prior authorization requests. This role entails close collaboration with healthcare professionals, ensuring quality documentation and efficient communication regarding authorizations. Candidates must possess an active LPN license and relevant experience in healthcare settings.

Qualifications

• 1-3 years of related work experience.
• Requires active LPN license in the state of practice.
• Education in Nursing preferred.

Responsibilities

• Answer inbound calls and process medication prior authorizations.
• Maintain accurate documentation and data management.
• Review prior authorizations based on policy and procedures.

Skills

Prior Authorization

Utilization Review

Education

High School Diploma or equivalent

Associate's or Bachelor's Degree in Nursing

Active LPN license in the state of practice

Job description

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Job Description

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.

You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the 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 oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies and members based on program criteria.

Responsibilities

• 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 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.
• 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.
  
  

Experience

• 1-3 years of related work experience.
  
  

Skills

• Prior Authorization
• Utilization Reeview
  
  

Education

• High School Diploma or equivalent required
• Associate’s or Bachelor’s Degree: Nursing preferred
• Other Certificates or Licenses (List): Active LPN license in the state of practice required
  
  

About US Tech Solutions

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com/) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

If you have questions about this posting, please contact [e-mail]

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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