Provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits
Review criteria-based prior authorizations following policy and procedure
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
Follow all prior authorization procedures to guarantee an accurate process on each prior authorization
Complete other PA assignments as delegated by the PA leadership team
Perform and handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve calls with a one call solution
Perform other related projects and duties as assigned, including attending training sessions and development meetings

Minimum 2 years clinical experience as an LPN/LVN
A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license
Prior authorization experience or Case Management experience
3+ years prior related clinical work experience
Ability to prioritize, quickly assess, manage multiple tasks, and adapt to constantly changing situations
Experience using MS Office and other Windows-based computer applications and phone use
Digital charting
Managed care or health plan previous experience
Call center experience
Multi-tasking experience
Prior remote experience preferred
Case Management experience preferred
Prior authorization experience
High production experience
Excellent organizational skills
Strong detail orientation

Prior Authorization Nurse Associate, LPN/LVN

Key skills