Company Description

Job Description

Requirements

**Training schedule is approximately three weeks starting 12/02/2024, Monday to Friday 8:00am - 4:30pm CST, then schedule will be assigned: Expected shifts to be 8 hours per day, Monday through Friday between 8am CST and 12AM CST, with potential weekend requirements. High School Diploma or equivalent required Associate’s or Bachelor’s Degree: Nursing preferred Other Certificates or Licenses (List): Active LPN license in the state of practice required 8 hour shift Monday to Friday anywhere between 8:00 am to 12:00 am CST; possible weekends

Responsibilities

You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the 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 and electronic authorizations, loading authorizations, and making follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards. 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.

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