Nurse Associate - Specialty Medical Precert Authorization LPN/LVN

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Position Summary
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.

Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and making follow-up phone calls. 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.

• Excellent verbal and written skills.

• 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.

Required Qualifications

• Must have active, current and unrestricted Licensed Practical/Vocational Nurse in state of residence

• 2+ years of LPN/LVN clinical experience

• 1+ years of experience using Microsoft Teams, including Word, Excel and Outlook

• Must be willing and able to work Monday through Friday, Sunday through Thursday or Tuesday through Saturday between hours of 8am to 8pm CST zone

Preferred Qualifications

• 1+ years prior work experience

• Prior work experience working prior authorizations in Novologix.

• Excellent interpersonal skills

• Demonstrated problems solving ability and attention to detail

• Ability to work effectively in a team environment with great dependability

• Excellent oral and written communication skills

• Ability to quickly assess and adapt to constantly changing situations, phone and PC use

• Required to possess a high mental agility and alertness

• Ability to effectively communicate with pharmacists, other clinical colleagues, healthcare professionals and members

• Ability to effectively prioritize work while exhibiting a high level of urgency with all calls and assignments

• Ability to effectively train and mentor representatives on the PA team

Education

Diploma or Certification from approved LPN/LVN program

Pay Range

The typical pay range for this role is:

$21.10 - $43.78

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant facto