[Hiring] Licensed Vocational Nurse @Iconma Portal

Role Description

Our client, a Retail Pharmacy company, is looking for a Licensed Vocational Nurse for their Remote location.

• 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, work with physician office staff and customer service, admissions, and pharmacy operations departments to communicate prior authorization 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 and electronic authorizations, load authorizations, and make follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards.
• Maintain complete and accurate documentation of all necessary information involving 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.
• Excellent verbal and written skills.
• 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.
• Registered Nurses (RNs) not accepted for LVN/LPN.
• 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.
• Manage case load 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.
• Act as a subject matter expert and assist with Coordinator duties dependent upon business needs.
• Provide support/mentoring to Coordinator staff to solve case processing questions and issues.
• Collaborate with Pharmacy Technicians, Pharmacists, and other internal partners for timely resolution of issues with case processing.
• Work closely with internal partners to develop work instructions and promote process improvements.
• Other duties assigned.

Qualifications

• Verifyable High School Diploma or GED Required
• Experience: 1-3 years experience

Benefits

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