Clinical Pharmacist

APIDEL LTD; United States; A distancia; USD 60.000 - 86.000; Jornada completa

Descripción de la vacante

APIDEL LTD seeks an experienced Licensed Practical Nurse (LPN) to handle high-volume prior authorization in a fully remote setting. The role requires strong clinical judgment, accuracy, and independence to interpret clinical information across systems.

Ideal candidates have 2+ years of prior authorization experience in PBM, MDO, or clinical settings, and a current LPN license. Remote work demands accountability, focus, and seamless communication with teams and providers.

Formación

• Active, unrestricted LPN/LVN license.
• Minimum 2+ years of prior authorization experience in PBM/MDO/clinical setting.
• Experience applying clinical criteria using supporting documentation.
• Experience using CoverMyMeds or similar platforms.
• Licensed as an LPN in the state of residence.

Responsabilidades

• Manage inbound and outbound calls while maintaining productivity and service levels.
• Review and process complex prior authorization requests using clinical criteria and documentation.
• Navigate multiple systems and platforms with speed and accuracy.
• Review chart notes, claims history, and prior authorization history to make determinations.

Conocimientos

Prior Authorization

Clinical judgment

Attention to detail

Communication

Educación

Practical Nursing Diploma (LPN)

Herramientas

CoverMyMeds

Descripción del empleo

Position: Licensed Vocational Nurse Prior Authorization

Location: Fully Remote

Duration: 12 Months (Higher extension possibilities)

Position Summary:

We are seeking experienced LPN/LVN candidates with prior authorization experience in a specialty medical office (MDO), PBM, or clinical setting. This role requires the ability to work in a high-volume, metrics-driven environment while maintaining strong clinical judgment, accuracy, and efficiency.

Successful candidates are self-directed, resourceful, and adaptable, with the ability to quickly interpret clinical information, navigate multiple systems simultaneously, and maintain productivity while managing competing priorities. This is a fully remote role requiring a high level of accountability, focus, and independence throughout the entire shift.

Duties

• Manage inbound and outbound calls while maintaining productivity, quality, and service level expectations
• Review and process complex prior authorization and appeals requests using clinical criteria and supporting documentation
• Navigate multiple systems, tools, and communication platforms simultaneously with speed and accuracy
• Review chart notes, claims history, and prior authorization history to make accurate determinations
• Submit complete and accurate documentation to support determinations and avoid unnecessary delays
• Identify cases requiring escalation and refer appropriately
• Demonstrate critical thinking and problem-solving when information is unclear or incomplete
• Apply internal workflows, job aids, and policies correctly and consistently
• Adapt quickly to changing priorities, processes, and clinical criteria
• Communicate clearly and professionally with team members, pharmacists, providers, and leadership
• Ask questions and seek clarification when needed to ensure accuracy
• Maintain attention to detail while processing high volumes of work efficiently
• Participate in quality assurance activities and apply feedback for continuous improvement
• Perform work in a sedentary, desk-based environment requiring prolonged sitting, typing, and screen time
• Maintain consistent attendance, productivity, and adherence to scheduled work hours

Experience

• Active, unrestricted LPN/LVN license
• Minimum 2+ years of recent prior authorization experience in a PBM, MDO, or clinical setting
• Experience reviewing and applying clinical criteria and supporting documentation for Pas
• Experience using CoverMyMeds or similar authorization platforms
• Familiarity with chart notes, claims history, and insurance requirements
• Licensed as an LPN in the state in which they reside.

Education

• Graduate of an accredited school of Practical Nursing (NLNAC or equivalent)
• Must maintain active licensure in good standing