Licensed Vocational Nurse (Prior Authorization)

SGS_JOB_2359

Nursing

Remote

LVN

Licensed Vocational Nurse

Prior Authorization

PBM

Pharmacy Benefit Management

Contract - 06+ Months

Shift: Training Period: First 8 weeks – no time off or vacations allowed Shift Range: Between 8:00 AM – 8:00 PM CST Weekend Requirement: Candidates must work one weekend day (either Sunday–Thursday or Tuesday–Saturday) This position is a 100% remote, work from home opportunity and will not be patient facing however need LVN with Prior Authorization experience.

Job Responsibilities:

Review complex clinical criteria-based prior authorizations (electronically and/or in written format) in accordance with policies and procedures and per the health plan/employer agreed criteria.
Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
Shift priorities while exhibiting a high level of urgency and responsiveness with all calls, prior authorization requests, and ADHOC assignments.
Follow all prior authorization procedures to meet business quality standards and ensure the operational unit is complying with regulatory requirements and accreditation standards.
Participates in quality assurance activities on ongoing basis, including but not limited to reviewing work instructions and job aids regularly.
Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members.
Complete other prior authorization assignments as delegated by the leadership team.
Utilization of clinical and problem-solving skills to support the research of documentation, communication of medical services, and prior authorization determinations.
Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment.
This position involves sedentary work with extended periods of sitting, talking on the telephone, using multiple programs on multiple computer screens, and keyboarding.
Must have regular and predictable attendance.
Colleague will be required to work overtime/work weekends when business requires.

Skills:

Hold and maintain an active, unencumbered LPN/LVN license in the state of practice.
Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows-based computer applications, web-based processing and telephony programs.
Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM).

Education/Experience:

The Licensed Practical Nurse is a graduate of a school of Practical Nursing, approved by the State Agency and/or accredited by the National League for Nursing Accrediting Commission (NLNAC) at the time the program was completed by the applicant. The LPN must have a full, active, and unrestricted license as a Licensed Practical in a State, Territory or Commonwealth of the United States or District of Columbia.

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Licensed Vocational Nurse (Prior Authorization)

Job Responsibilities:

Skills:

Education/Experience:

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