Job Description
Market leading managed care organization looking for remote/work from home Prior Authorization LPN/LVNs! Great opportunity, please call us today!
Location: 100% Remote - Work from Home, U.S.
Position Summary
The Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN) will support the Commercial Prior Authorization (PA) team for pharmacy benefits.
This is a 100% remote, non-patient-facing, high-production role with defined productivity and quality metrics.
Reporting to the Pharmacy Operations Manager, the LPN/LVN will work closely with physician office staff, pharmacists, healthcare professionals, customer service, pharmacy operations, and members to process and communicate prior authorization requests and determinations.
Key Responsibilities
-Review criteria-based prior authorization requests in accordance with established policies and procedures.
-Process and document Commercial Pharmacy Prior Authorization cases accurately and efficiently.
-Provide clinical and operational support to the Prior Authorization and Member Services teams.
-Refer cases that do not meet established clinical criteria to the appropriate Pharmacist and/or Medical Director team.
-Process faxes, authorization requests, and related documentation.
-Load and maintain authorizations within applicable systems.
-Handle inbound and outbound calls with prescriber offices, pharmacies, healthcare providers, members, technicians, and internal teams.
-Respond to inquiries and facilitate prior authorization requests with a focus on first-call resolution when applicable.
-Make follow-up calls regarding authorization requests and case status.
-Utilize clinical knowledge to support documentation and communication of medical services and prior authorization determinations.
-Maintain complete, accurate, and timely documentation in applicable systems.
-Perform computer system data entry, data management, and reporting activities.
-Collaborate with pharmacists, nurses, healthcare professionals, and other clinical and operational colleagues.
-Shift priorities as needed while maintaining a high level of urgency and accuracy.
-Meet established productivity, quality, and performance metrics.
-Multitask effectively and adapt to a fast-paced, continuously changing environment.
-Attend required training sessions, development meetings, and team activities.
-Perform other related duties and projects as assigned by PA leadership.
Required Qualifications
Active, unrestricted LPN or LVN license in the candidate's state of residence or a valid compact license.
Recent Prior Authorization experience, preferably involving pharmacy benefits.
Prior authorization experience in a specialty medical office (MDO), PBM, or clinical setting.
Minimum 2 years of clinical experience as an LPN/LVN.
Experience in managed care, health plan, payer, PBM, or utilization management environments preferred.
Experience working in a high-volume, metrics-driven healthcare environment.
Strong ability to prioritize, assess situations quickly, manage multiple tasks, and adapt to changing priorities.
Schedule:Schedules are assigned based on business needs and may include:
Sunday-Thursday or Tuesday-Saturday
Shifts between 10:00 AM-6:30 PM CST based on business needs and mandatory OT required
Training: 8:00 AM-4:30 PM CT, Monday-Friday
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Temporary work, Work experience placement, Work at office, Remote work, Monday to Friday, Shift work