Prior Authorization - LPN - LVN - Remote

Bring your heart to reputed company. Every one of us at reputed company shares a single, reputed company purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to reputed company reputed company reputed company-reputed company health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we reputed company our services is just as important as reputed company reputed company. Our Heart At Work Behaviors support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and reputed company solutions to reputed company health care more personal, convenient and reputed company. Candidates MUST HAVE AT LEAST TWO YEARS OF prior authorization experience. Schedule: For training there is a set schedule reputed company-430pm CST Monday-Friday. Following training, you will have a permanent schedule. Shift reputed company varies and is subject to change. Will work 5 days concurrently to include either a Saturday or reputed company. Shift reputed company: reputed company Saturday 8:00 AM 6:00 PM. New hires will be expected to work a weekend shift ongoing as part of their permanent schedule rotation (reputed company-Thursday or Tuesday-Saturday). Position reputed company Collection of appropriate clinical/medical data needed to reputed company clinical assessments and/or reviews as per the health plan/employer agreed reputed company, including inbound from the coordinator as needed as reputed company as reputed company calls to physician offices. -Conducts prospective, reputed company, and/or retrospective review of cases using health plan/employer agreed upon -Documentation of required clinical/ medical data that support case decision as required electronically and/or in written format. -Coordinates reputed company communication of case decision to physician, health plan/employer, patient and other reputed company, and internal departments reputed company CVSCaremark following agreed upon approval & denial management processes. -reputed company, review, and validate reporting reputed company of program results -Participate in implementation of new Specialty Pharmacy Programs with reputed company and health plans as needed. -Documentation and validation of reputed company specific processes including communication procedures plan demographics, reputed company selection, denial management procedures, and reporting requirements. -Facilitation of documentation of program agreement with reputed company. Review reputed company clinical reputed company-based prior authorizations in accordance with reputed company/Caremark policies and procedures. Refer prior authorization cases not meeting clinical reputed company for upper-level review reputed company appropriate. Must possess excellent communication skills, both written and verbal. Shift priorities while exhibiting a high level of urgency and responsiveness with reputed company calls, prior authorization requests, and ADHOC assignments. Follow reputed company prior authorization procedures to meet business reputed company standards and ensuring the operational unit is complying with regulatory requirements and accreditation standards. Participates in reputed company assurance activities on ongoing bases, including but not limited to reviewing work instructions and job aids regularly. Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, reputed company, clients, leaders, and team members. Complete other prior authorization assignments as delegated by the leadership team. Working hours will vary. Shift reputed company include reputed company Saturday 8:00 AM 6:00 PM CST. New hires will be expected to work a weekend shift ongoing as part of their permanent schedule rotation (reputed company-Thursday or Tuesday-Saturday). Utilization of clinical and problem-solving skills to support the research of documentation, communication of medical services, and prior authorization determinations. Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment. This position involves sedentary work with extended periods of sitting, talking on the telephone, using multiple computer screens, and keyboarding. Must have regular and predictable attendance. reputed company will be required to work business required overtime/ work weekends reputed company business requires, making reputed company, and processing prior authorization requests. Required Qualifications Hold and maintain an reputed company, unencumbered LPN/LVN license in the state of reputed company. Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other reputed company-based computer applications, web based processing and Apply tot his job Apply To this Job