Licensed Practical Nurse

3 days ago Be among the first 25 applicants Direct message the job poster from LanceSoft Inc., Licensed Vocational Nurse/Licensed Practical Nurse - Prior Authorization Position type: Full time Location: Fully remote Onsite Flexibility: All Remote Pay range: ($25.00 - $28.50) Job Description: Candidate should be located and licensed in North Carolina for a specific project. 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 client 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 ensure the operational unit is complying with regulatory requirements and accreditation standards. Participate in quality assurance activities on an ongoing basis, 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. Utilize 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 LPN/LVN 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 1-2 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: LPN/LVN must have a full, active, and unrestricted license as a Licensed Practical or Vocational Nurse. Schedule: Monday to Friday 8:00am - 4:30pm CST, then schedule will be assigned: Expected shifts to be 8 hours per day, which will include one weekend day per week. 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 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. #J-18808-Ljbffr