LPN/LVN Prior Authorization Nurse

Market leading managed care organization looking for remote/work from home Prior Authorization LPN/LVNs!

**Must have prior authorization experience in an MDO, PBM, or clinical setting**

Location: 100% Remote

West coast canidates Needed!

****PST and MST time zones preferred.****

Position Summary

The Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)

will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the 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 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.

*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.

Required Qualifications

**Must have prior authorization experience in an MDO, PBM, or clinical setting**

Active, unrestricted LPN or LVN license in the candidate's state of residence or a valid compact license.

Minimum 2 years of clinical experience as an LPN/LVN.

Recent Prior Authorization experience, preferably involving pharmacy benefits.

Experience in managed care, health plan, payer, PBM, or utilization management environments preferred.

Experience working in a high-volume, metrics-driven healthcare environment.

Strong ability to prioritize, assess situations quickly, manage multiple tasks, and adapt to changing priorities.

Ability to work independently in a fully remote environment.

Ability to maintain regular and predictable attendance.

Schedule:

8 hour shift Monday to Friday anywhere between 8:00 am to 12:00 am CST; possible weekends

The work schedule will be determined after training is completed;

Training: 8:00 AM-4:30 PM CT, Monday-Friday

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 View email address on us.fitly.work.




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.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.




Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.




Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.




We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.