Prior Authorization Nurse Associate LPN/LVN
Core
Processing and communication of Commercial Prior Authorizations (PA) for Pharmacy benefits, serving prescriber office staff, pharmacies, and members.
Role type
Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) - Prior Authorization Specialist
Builds
Accurate prior authorization determinations and documentation for pharmacy benefits
Domain
Healthcare / Pharmacy Benefits / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical judgment, policy adherence, data entry, telephone communication, multitasking, case prioritization, system navigation
Preferred skills
Prior authorization experience, case management experience, managed care experience, call center experience, remote work experience
Technologies
MS Office, Windows-based applications, digital charting systems
Responsibilities
Review criteria-based prior authorizations following policy and procedure, answer inbound and outbound phone calls to facilitate requests, process cases and load authorizations, refer cases not meeting clinical criteria to Pharmacist and MD teams, maintain accurate documentation of all necessary information, complete delegated PA assignments
Seniority
Mid-level, hands-on IC