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 nurse associate, lpn in pacific, mountain or central time zones. this role is remote. the schedule is as follows 7am to 12am cst - 8 hours per day expected. scheduled to start dec 5th. apply now!
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.
schedule: **training schedule is approximately three weeks starting 12/05/2022, 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.
responsibilities include answering inbound phone calls, processing cases, 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.
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/lvn license in the state of practice required.
0-3 years' experience
strong detail orientation with excellent verbal and written skills.
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.
demonstrated problem-solving ability.
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.
work from home requirements:
workspace is dedicated to business during working hours and is not accessible by others who may be present in the household; telephone conversations cannot be overheard, and documents/computer screens cannot be viewed by others.
you are required to provide your high speed internet speeds.
minimal home broadband connectivity speed of 25 mb download and 3 mb upload speed. speed for home internet can be confirmed by going to www.speedtest.net.
smartphones are required. the vpn token will need to be downloaded to the user’s smartphone.
click on apply now for instant consideration!
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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