What are the responsibilities and job description for the Licensed Vocational Nurse position at Integrated Resources, Inc?
This employer requires all employees, temporary labor, consultants, and contractors to be fully vaccinated aProductst 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
RAMP - Clinical Commercial Attrition
RNs will be considered as well - IF THEY ARE OK WITH CURRENT RATE STRUCTURE ON POSTING
What days & hours will the person work in this position? List training hours, if different.
8 hour shift Monday to Friday anywhere between 8 : 00 am to 12 : 00 am CST; possible weekends
Duties
1.Effectively manage work volume by handling inbound calls / fax requests utilizing appropriate courteous and professional behavior based upon established standards. Sort incoming faxes in compliance with departmental and client requirements.
2.Manage case load for all clients by researching and triaging incoming fax requests. Use eligibility systems to identify the type of request and create, route, and / or complete appeals or requests in accordance with department processes. Process External Review appeal requests according to federal, client, and state mandated guidelines.
3.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.
4.Collaborate with Pharmacy Technicians, Pharmacists, and other internal partners for timely resolution of issues with case processing.
5.Works closely with internal partners to develop work instructions and promote process improvements.
6.Other duties assigned.
Experience
1-3 years experience
Ability to deal with a diverse customer base in a friendly and confident manner (internal and external customers). Proficient with computer systems and Microsoft Office skills, including Access, Excel and Word. Ability to navigate systems in Windows and web-based programs, and quickly learn new applications. Ability to prioritize and manage multiple tasks. Demonstrated sense of urgency with assignments. Excellent organization skills. Strong detail orientation.
Demonstrated problem-solving ability. Strong verbal and written communication skills. Ability to maintain confidentiality. Knowledge of claim eligibility processes. Works well as a member of a team with strong interpersonal skills. Seeks ways to collaborate and reach consensus with peers. Actively works to build strong working relationships.
Able to customize messages and deliver to broader audiences. Background in creating and maintaining reports is a plus.
Position Summary
The Nurse Associate LPN - Prior Authorization is responsible for the efficient, accurate and timely prioritization and management of work. Provides support to the Prior Authorization Department in meeting client expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making. Responsible for maintaining compliance with ERISA, CMS, and client specific requirements. Works as part of the team to meet business unit objectives. This position is also responsible for receiving calls from physician offices and providing professional and courteous assistance to all callers through the criteria-based process. The Nurse Associate LPN will follow criteria question set prompts to facilitate system-generated approvals. Further responsibilities include maintaining complete, timely, and accurate documentation of all requests, communicating to the physician s office, pharmacies, intake etc. as needed, and transfers all clinical questions and judgement calls to the Clinical Pharmacist as needed. The Nurse Associate LPN will also assist with other duties such as outbound calls, monitoring / responding to inquiries in mailboxes and other duties as assigned by the leadership team. The Nurse Associate LPN will support requirements of the PA team by working as part of a weekend coverage team on a rotating basis where needed.
Education
Associate s (REQUIRED) or Bachelor s Degree : Nursing preferred
Other Certificates or Licenses (List) : Active LPN license in the state of practice required
The Licensed Practical Nurse is a graduate of a school of Practical or Vocational Nursing, approved by the State Agency and / or accredited by the National League for Nursing (Accrediting Commission (NLNAC)) at the time the program was completed by the applicant. The LPN / LVN must have a full, active and unrestricted license as a Licensed Practical or Vocational Nurse in a State, Territory or Commonwealth of the United States or District of Columbia.
RNs will be considered as well - IF THEY ARE OK WITH CURRENT RATE STRUCTURE ON POSTING
What days & hours will the person work in this position? List training hours, if different.
8 hour shift Monday to Friday anywhere between 8 : 00 am to 12 : 00 am CST; possible weekends
Type of Start
Class with set start date
Is this an in-person, patient-facing role?
Onsite Requirements
Fully remote (never coming onsite)
