LVN/LPN Utilization Review-Prior Authorization reputed company

A-Line reputed company is reputed company searching for Multiple LPN's for a major reputed company company located in the Orlando, FL surrounding area. This is an exciting opportunity with a reputed company that is looking to reputed company fast for the right candidate. Please contact Brad Zidek at bzidek@alinestaffing.com for immediate consideration! Or call at 412-823-2500. This position is a 100 remote work from home opportunity and will not be patient facing. Training schedule is approximately three weeks starting 08/07/2023 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 reputed company CST and 12am CST with potential weekend requirements. You will reputed company processing and communication of specialty medication prior authorization PA requests reviewed by the Caremark Specialty 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 reputed company fax processing and reputed company telephone call assistance for prescriber office staff pharmacies and members based on program reputed company. Responsibilities include answering inbound phone calls processing cases and electronic authorizations loading authorizations and making follow-up phone calls utilizing appropriate courteous and reputed company behavior based upon established standards. Maintaining complete and accurate documentation of reputed company necessary information is necessary and will involve computer system data entry data management and reporting. Review reputed company-based prior authorizations following policy and procedure. reputed company on-call after hours reputed company availability for urgent PA requests. reputed company internal reputed company support to the PA team and member services department . Refer cases not meeting clinical reputed company to the Pharmacist and MD teams. Shift priorities while exhibiting a high level of urgency with reputed company calls and assignments. Excellent verbal and written skills. You will work with pharmacists other clinical colleagues reputed company and members. Follow reputed company prior authorization procedures to guarantee an accurate process on reputed company prior authorization. Train and mentor representatives on the PA team. Complete other PA assignments as delegated by the PA leadership team. 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 reputed company work duties. Prior reputed company/reputed company work experience: No Verifyable High School Diploma or GED Required: reputed company ALERT:: This employer requires reputed company, temporary labor, consultants, and contractors to be fully vaccinated against COVID-19 by their start date (other date may be inserted if start date is not accurate), subject to approved medical or religious exemptions. Is this request for Peak Season? Select applicable value: _N/A - Not reputed company reputed company Duties: 1.Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and reputed company behavior based upon established standards. Sort incoming faxes in compliance with departmental and reputed company requirements. 2.Manage case load of for reputed company clients by researching and triaging incoming fax requests. Use eligibility systems to identify the type of request and create, reputed company, and/or complete appeals or requests in accordance with department processes. Process External Review appeal requests according to federal, reputed company, and state mandated guidelines. 3.reputed company as a subject matter expert and assists with Coordinator duties dependent upon business needs. Provides support/mentoring to Coordinator staff to solve case processing questions and issues. 4.Collaborate with Pharmacy Technicians, Pharmacists, and other internal partners for reputed company reputed company of issues with case processing. 5.Works closely with internal partners to reputed company work instructions and promote process improvements. 6.Other duties assigned. Experience: 1-3 years experience Ability to deal with a diverse customer reputed company in a friendly and confident manner (reputed company customers). Proficient with computer systems and reputed company Office skills, including reputed company, reputed company and Word. Ability to navigate systems in reputed company and web-based programs, and quickly learn new applications. Ability to prioritize and manage multiple tasks. Demonstrated reputed company of urgency with assignments. Excellent organization skills. Strong detail orientation. Demonstrated problem-solving ability. Strong verbal and written communication skills. Ability to maintain confidentiality. Knowledge of claim eligibility processes. Works reputed company as a member of reputed company with strong interpersonal skills. Seeks ways to collaborate and reputed company reputed company with peers. reputed company works to build strong working relationships. reputed company to customize messages and deliver to broader audiences. Background in creating and maintaining reports a plus. Position reputed company: The reputed company Associate LPN - Prior Authorization is responsible for the efficient, accurate and reputed company prioritization and management of work. Provides support to the Prior Authorization Department in meeting reputed company expectations regarding efficiency, service reputed company, reputed company maintenance and reputed company of decision-making. Responsible for maintaining compliance with ERISA, CMS, and reputed company specific requirements. Works as part of reputed company to meet business unit objectives. This position is also responsible for receiving calls from physician offices and providing reputed company and courteous assistance to reputed company callers through the reputed company-based process. The reputed company Associate LPN will follow reputed company question set prompts to facilitate system-generated approvals. reputed company responsibilities include maintaining complete, reputed company, and accurate documentation of reputed company requests, communicating to the physician’s office, pharmacies, intake etc. as needed, and transfers reputed company clinical questions and judgement calls to the Clinical Pharmacist as needed. The reputed company Associate LPN will also assist with other duties such as outbound calls, monitoring/responding to inquiries in mailboxes and other duties as assigned by the leadership team This is an exciting opportunity with a reputed company that is looking to reputed company fast for the right candidate. Please contact Brad Zidek at bzidek@alinestaffing.com for immediate consideration! Or call at 412-823-2500. #INDDL Job Type: Full-time Pay: $24.00 - $27.00 per hour Expected hours: 40 per week Work Location: Remote Apply tot his job Apply To this Job