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**Important Note:** Candidates in Mountain Time zone or Pacific Time zone are preferred.

Job Description:

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.

You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Aetna 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 oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies and members based on program criteria.

Responsibility:

Responsibilities include answering inbound phone calls, processing cases and electronic authorizations, loading authorizations, and making follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.

+ 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 pharmacists, other clinical colleagues, healthcare professionals and members.

+ 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.

Required Qualifications

+ 2+ years of LPN/LVN clinical experience.

+ **Prior Authorization experience is required.**

+ **Utilization Review Experience is also required.**

+ 1+ years of experience using Microsoft Teams, including Word, Excel and Outlook

+ Prior work experience working prior authorizations in Novologix.

+ Ability to effectively train and mentor representatives on the Prior Auth team.

Education:

The Licensed Practical Nurse is a graduate of a school of Practical or Vocational Nursing, approved by the State Agency and/or accredited by the National League for Nursing (Accrediting Commission (NLNAC)) at the time the program was completed by the applicant. The LPN/LVN must have a full, active and unrestricted license as a Licensed Practical or Vocational Nurse in a State, Territory or Commonwealth of the United States or District of Columbia.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.