Nurse associate, lpn - work from home specialty medical prior authorizations and appeals - united states, woonsocket

adecco is currently assisting a national pharmaceutical client, recruiting for a lpn.  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.

 

training schedule is approximately three weeks starting 9/12/2022, 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. this position is a 100% remote, work from home opportunity and will not be patient facing. apply now!

 

lpns require candidates to:

 

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.

 

candidates must meet the following requirements to be considered: 

 

active lpn license in the state of practice required.

0-3 years' experience.

proficient with computer systems and microsoft office skills, including access, excel and word.

background in creating and maintaining reports a plus.

 

 

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.

 

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.

equal opportunity employer/veterans/disabled



the company will consider qualified applicants with arrest and conviction records

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