∙ 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.
Best Value
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Advanced
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Basic
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