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Practical Nurse Specialist
2 months ago
Position Overview:
As a Practical Nurse Specialist, you will be responsible for managing the processing and communication of specialty medication prior authorization (PA) requests, collaborating closely with the Caremark Specialty Medical Prior Authorization team.
In this role, you will report directly to the Pharmacy Operations Manager and engage with physician office personnel, customer service, admissions, and pharmacy operations to relay prior authorization statuses effectively.
Your duties will also include overseeing fax processing and providing telephonic support for prescriber office staff, pharmacies, and members in accordance with program guidelines.
Key Responsibilities:
• Evaluate criteria-based prior authorizations in alignment with established policies and procedures.
• Offer on-call after-hours nursing support for urgent PA requests.
• Provide internal nursing assistance to the PA team and member services division.
• Escalate cases that do not meet clinical criteria to the Pharmacist and MD teams.
• Adapt to shifting priorities while maintaining a high level of urgency in all communications and tasks.
• Exhibit excellent verbal and written communication skills.
• Collaborate with pharmacists, clinical colleagues, healthcare professionals, and members.
• Adhere to all prior authorization protocols to ensure precision in each authorization process.
• Mentor and train representatives within the PA team.
• Complete additional PA tasks as assigned by the PA leadership team.
Qualifications:
• Minimum of 1 year of experience as a Licensed Practical Nurse (LPN).
Skills Required:
• Proficiency in prior authorization processes.
Educational Background:
• Graduate from an accredited Practical or Vocational Nursing program.
About US Tech Solutions:
US Tech Solutions is a global staffing augmentation firm offering a diverse range of talent on-demand and comprehensive workforce solutions.
To learn more about US Tech Solutions, please visit our website.US Tech Solutions is an Equal Opportunity Employer.
All qualified candidates 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.
