What are the responsibilities and job description for the Licensed Practical Nurse LPN- Remote- Prior Authorization/appeals position at RemoteWorker US?
Job Description
Job Description
A-Line Staffing is actively searching for Multiple LPN's for a major healthcare company located in the Orlando, FL surrounding area. This is an exciting opportunity with a client that is looking to move fast for the right candidate. Please contact Brad Zidek at bzidek@alinestaffing.com for immediate consideration! Or call at 412-823-2500.
This position is a 100 remote work from home opportunity and will not be patient facing. **Training schedule is approximately three weeks starting 08/07/2023 Monday to Friday 8:00am - 4:30pm CST then schedule will be assigned: Expected shifts to be 8 hours per day Monday through Friday between 8am CST and 12am CST with potential weekend requirements. You will provide processing and communication of specialty medication prior authorization PA requests reviewed by the Caremark 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 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 teams. 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. ** 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.
Prior CVS/Aetna work experience: No Verifyable High School Diploma or GED Required: Yes ALERT:: This employer requires all employees, temporary labor, consultants, and contractors to be fully vaccinated against 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: _N/A - Not RAMP Related 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 of 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 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
This is an exciting opportunity with a client that is looking to move fast for the right candidate. Please contact Brad Zidek at bzidek@alinestaffing.com for immediate consideration! Or call at 412-823-2500.
Job Description
A-Line Staffing is actively searching for Multiple LPN's for a major healthcare company located in the Orlando, FL surrounding area. This is an exciting opportunity with a client that is looking to move fast for the right candidate. Please contact Brad Zidek at bzidek@alinestaffing.com for immediate consideration! Or call at 412-823-2500.
This position is a 100 remote work from home opportunity and will not be patient facing. **Training schedule is approximately three weeks starting 08/07/2023 Monday to Friday 8:00am - 4:30pm CST then schedule will be assigned: Expected shifts to be 8 hours per day Monday through Friday between 8am CST and 12am CST with potential weekend requirements. You will provide processing and communication of specialty medication prior authorization PA requests reviewed by the Caremark 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 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 teams. 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. ** 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.
Prior CVS/Aetna work experience: No Verifyable High School Diploma or GED Required: Yes ALERT:: This employer requires all employees, temporary labor, consultants, and contractors to be fully vaccinated against 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: _N/A - Not RAMP Related 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 of 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 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
This is an exciting opportunity with a client that is looking to move fast for the right candidate. Please contact Brad Zidek at bzidek@alinestaffing.com for immediate consideration! Or call at 412-823-2500.
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