Prior Authoization LPN/LVN

Randstad USA; Tulsa (OK); À distance; USD 37 000 - 38 000; Temps partiel

Avantages offerts par ce poste

Medical Insurance

401K plan

Short-term disability

Résumé du poste

Randstad USA seeks a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) to support Commercial Prior Authorizations (PA) and Appeals for Pharmacy benefits. Works with physician offices, customer service, admissions and pharmacy operations to communicate referral status, via remote work.

Responsibilities include processing, telephone support for prescribers, pharmacies and members, and training PA/Appeals staff.

Qualifications

• Active, unrestricted LPN/LVN license.
• 2+ years of prior authorization experience in PBM/clinical setting.
• Experience reviewing and applying clinical criteria for PAs.
• Familiarity with chart notes, claims history, and insurance requirements.

Responsabilités

• Answer inbound calls and process cases and determinations for PA/Appeals.
• Maintain accurate documentation and data entry in the system.
• Refer cases not meeting criteria to Pharmacist/MD teams.
• Train and mentor representatives on PA/Appeals processes.
• Support communication of referral status to prescribers and members.

Connaissances

Prior authorization

Clinical criteria review

Communication skills

Formation

High School diploma

Outils

CoverMyMeds

Description du poste

Job Summary

The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) will provide processing and communication of Commercial Prior Authorizations (PA) and Appeals reviewed by the Commercial PA and Appeals team for Pharmacy 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.

Location: Remote

Job type: Contract

Salary: $27.00 - $27.87 per hour

Work hours: 8 Hour Shifts M-F between 8:00am-7:00pm CT.

Education: High School diploma

Responsibilities

• Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and determinations, 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.
• Review criteria-based prior authorizations/appeals following policy and procedure
• Provide internal nurse support to the PA/Appeals 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 and appeals procedures to guarantee an accurate process on each prior authorization.
• Train and mentor representatives on the PA/Appeals team.
• Complete other PA/Appeals assignments as delegated by the PA/Appeals leadership team.
• Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations
• Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment"

Qualifications

• Active, unrestricted LPN/LVN license Minimum 2+ years of recent prior authorization experience in a PBM, MDO, or clinical setting
• Experience reviewing and applying clinical criteria and supporting documentation for PAs
• Experience using CoverMyMeds or similar authorization platforms
• Familiarity with chart notes, claims history, and insurance requirements
• Licensed as an LPN in the state in which they reside.

Skills

• Prior authorization - PBM, MDO, or clinical setting: 2 yearsReviewing/applying clinical criteria & supporting docs: 1 year

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [e-mail].

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.