Licensed Vocational Nurse - LPN

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The UM Nurse Associate I is responsible for reviewing and completing criteria-based prior authorizations in compliance with company policies and procedures. This role provides after-hours nurse availability for urgent prior authorization requests, supports the PA team and member services, and refers cases requiring clinical review to the Pharmacist or MD team.

Answer inbound nurse queue calls promptly, including escalated calls. Serve as the final decision-maker for all prior authorization approvals. Refer cases not meeting clinical criteria to secondary review for final decision by a pharmacist. Work distributed case volumes and client exceptions. Maintain accurate, timely documentation of calls and clinical information obtained. Ensure proper processing, review, and maintenance of all PA paperwork. Participate in ongoing training and development sessions. Maintain and update desk reference materials. Train and mentor PA team representatives as needed. Execute other assignments as directed by the PA supervisor or manager.