Licensed Practical Nurse - Prior Authorization

Remote Prior Authorization Nurse

This is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA compliant work area away from distractions, and must have their own secure private internet services of at least 25mbps download/3mbps upload in order to ensure sufficient speed to adequately perform work duties. Must provide a screenshot of internet speeds with resume and provide license number.

Responsibilities:

• 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.
• You will work with pharmacist...