Prior Authorization Nurse Associate LPN/LVN

Position Summary

The Licensed Practical Nurse (LPN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits.

Responsibilities

• Review criteria-based prior authorizations following policy and procedure
• 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
• Work with pharmacists, other clinical colleagues, healthcare professionals, and members
• Follow all prior authorization procedures to guarantee an accurate process on each prior authorization
• Complete other PA assignments as delegated by the PA leadership team
• Utilize clinical skills to support the documentation and communication of medical services and prior authorization determinations
• Able to multitask, prioritize, and effectively adapt to a fast-paced changing environment
• This position involves sedentary work with periods of sitting, talking, listening
• Requires sitting for extended periods, talking on the telephone, and typing on the computer

Qualifications

• Minimum 2 years clinical experience as an LPN/LVN
• An LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license
• Prior authorization experience or Case Management experience
• 3+ years prior related clinical work experience
• Experience prioritizing, quickly assessing, managing multiple tasks, and adapting to constantly changing situations
• Experience using MS Office and other Windows-based computer applications and phone use
• Digital charting
• Managed care or health plan previous experience
• Call center experience
• Multitasking experience
• Prior remote experience preferred
• Case Management experience preferred
• Prior authorization experience
• High production experience
• Excellent organizational skills
• Strong detail orientation