Licensed Vocational Nurse

About This Role

This role involves processing and communicating specialty medication prior authorization requests. The Licensed Vocational Nurse will work remotely, handling inbound calls, cases, and follow-up communications while maintaining HIPAA compliance.

Responsibilities

• Answer inbound phone calls, process cases and electronic authorizations, load authorizations, and make follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards
• Maintain complete and accurate documentation of all necessary information using 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
• 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

Requirements

• 1-3 years of related work experience
• High School Diploma or equivalent
• Active LPN license in the state of practice
• Prior Authorization experience
• Utilization Review experience

Qualifications

• High School Diploma or equivalent required, Associate’s or Bachelor’s Degree: Nursing preferred
• 1-3 years of related work experience

Nice to Have

• Associate’s or Bachelor’s Degree in Nursing