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Licensed practical nurse

1 month ago

Woonsocket, United States US Tech Solutions Full time

Job Description:

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:

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.

Experience:

1+ year as LPN

Skills:

Prior authorization

Education:

Graduate of a school of Practical or Vocational Nursing

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit .

US Tech Solutions is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,

national origin, disability, or status as a protected veteran.