[Hiring] Licensed Practical Nurse @Iconma Portal

Role Description

Our Client, a Retail Pharmacy, is looking for a Prior Authorization Licensed Vocational Nurse (LPN/LVN) to work remotely within the United States.

• Provide processing and communication of Commercial Prior Authorizations (PA) and Appeals reviewed by the Commercial PA and Appeals team for Pharmacy benefits.
• Work with physician office staff and customer service, admissions, and pharmacy operations departments to communicate referral status.
• Oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies, and members based on program criteria.
• Answer inbound phone calls, process cases, load authorizations, and determinations, and make follow-up phone calls.
• Maintain complete and accurate documentation of all necessary information, involving computer system data entry, data management, and reporting.
• Review criteria-based prior authorizations/appeals following policy and procedure.
• Provide internal nurse support to the PA/Appeals 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.
• Follow all prior authorization and appeals procedures to guarantee an accurate process on each prior authorization.
• Train and mentor representatives on the PA/Appeals team.
• Complete other PA/Appeals assignments as delegated by the PA/Appeals leadership team.
• Utilize clinical skills to support the documentation and communication of medical services and prior authorization determinations.

Qualifications

• Active unrestricted LPN/LVN license.
• Minimum 6 months prior authorization experience.
• Prior appeals experience is preferred.
• PBM, specialty pharmacy, payer, or medical office (MDO) experience.
• Experience reviewing and applying clinical criteria and supporting documentation for PAs.
• Experience using CoverMyMeds or similar authorization platforms.
• Familiarity with chart notes, claims history, and insurance requirements.

Benefits

• Health Benefits.
• Referral Program.
• Excellent growth and advancement opportunities.