License Practical Nurse

not applicable; United States; Teletrabalho; USD 37 000 - 40 000; Tempo integral

Resumo da oferta

N/A is seeking an LPN/LVN Prior Authorization Specialist for a fully remote position in the United States. The role demands experience with prior authorization in PBM/MDO or clinical settings, strong clinical judgment, and the ability to work independently in a fast-paced, metrics-driven environment.

Training runs 8 weeks with a schedule including weekends depending on business needs. Salary is $27.50 per hour on W2, with 8-hour shifts between 8 AM and 8 PM CST, and mandatory overtime as needed.

Qualificações

• Active, unrestricted LPN/LVN license.
• Experience reviewing and applying clinical criteria for PAs in PBM/MDO/clinical settings.
• Experience using authorization platforms (e.g., CoverMyMeds).
• Ability to work in a fast-paced, high-production, metrics-driven environment.
• Strong time management and independent work skills.

Responsabilidades

• Manage inbound and outbound calls while maintaining productivity and service levels.
• Review and process complex prior authorization requests using clinical criteria.
• Navigate multiple systems and tools quickly and accurately.
• Review chart notes, claims history, and prior authorization history for determinations.
• Submit accurate documentation to support determinations and avoid delays.
• Escalate cases when needed and communicate clearly with team and providers.
• Maintain attention to detail during high-volume work and adapt to changing priorities.
• Work remotely with accountability and consistent attendance.

Conhecimentos

LPN/LVN license

Prior authorization

Multitasking

Attention to detail

Remote work

High-volume environment

Phone calls

Clinical criteria

Communication

Formação académica

LPN/LVN license

Ferramentas

CoverMyMeds

Descrição da oferta de emprego

Hours:Work hours vary from 8AM to 8PM CST. Training hours 8AM - 430PM CT. Mandatory OT.

Pay Rate: $27.50/hr. on W2

Description:

Position Summary:

• LPN/LVN Prior Authorization Specialist
• 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 ahigh-volume, metrics-driven environmentwhile maintaining
• strong clinical judgment, accuracy, and efficiency.
• Successful candidates areself-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 requiringa high level of accountability, focus, and independence throughout the entire shift.

Prescreen Requirements:

• Submit prescreen answers along with resume- for all questions
• Provide internet speed and service type
• Must be able to hardwire PC into modem/router
• Submit copy of active LPN/LVN license with expiration date
• Submit completed computer skills assessment with resume
• Must have prior authorization experience in an MDO, PBM, or clinical setting

Training Schedule

• Monday–Friday, 8:00 AM–4:30 PM CST.
• Training duration: 8 weeks (may extend due to holidays)
• Permanent Schedule
• Schedules are assigned based on business needs and may include:
• Sunday–Thursday or Tuesday–Saturday
• Shifts between 10:00 AM–6:30 PM CST
• Schedule flexibility, overtime, and weekend availability are required.

Key Responsibilities:

• Manage inbound and outbound calls while maintainingproductivity, quality, and service level expectations.
• Review and process complex prior authorization requests using clinical criteria and supporting documentation.
• Navigatemultiple systems, tools, and communication platforms simultaneouslywith 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
• Demonstratecritical thinking and problem-solving when information is unclear or incomplete
• Apply internal workflows, job aids, and policies correctly and consistently
• Adapt quickly tochanging 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
• Maintainattention to detail while processing high volumes of work efficiently
• Participate in quality assurance activities and apply feedback for continuous improvement
• Perform work in asedentary, desk-based environmentrequiring prolonged sitting, typing, and screen time
• Maintain consistent attendance, productivity, and adherence to scheduled work hours

Required Qualifications

• Active, unrestricted LPN/LVN license
• Minimum2+ years of recent prior authorization experiencein 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
• Technical Skills
• Ability tomultitask across multiple monitors and applications simultaneously
• Advanced keyboarding skills, with the ability to type quickly and accurately
• Behavioral and Work Style Requirements
• Proven ability to work in afast-paced, high-production, metrics-driven environment
• Strong attention to detail while maintaining speed and accuracy
• Ability to learn quickly and work independently with limited guidance
• Strong time management and organizational skills in a remote setting
• Ability toremain focused and productive while working independently for full shifts

Responsibilities:

Manage inbound and outbound calls while maintainingproductivity, quality, and service level expectations

Review and process complex prior authorization requests using clinical criteria and supporting documentation

Navigatemultiple systems, tools, and communication platforms simultaneouslywith 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

Demonstratecritical thinking and problem-solving when information is unclear or incomplete

Apply internal workflows, job aids, and policies correctly and consistently

Adapt quickly tochanging 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

Maintainattention to detail while processing high volumes of work efficiently

Participate in quality assurance activities and apply feedback for continuous improvement

Perform work in asedentary, desk-based environmentrequiring prolonged sitting, typing, and screen time

Maintain consistent attendance, productivity, and adherence to scheduled work hours

Experience:

• Active, unrestricted LPN/LVN license
• Minimum2+ years of recent prior authorization experiencein 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
• Technical Skills
• Ability tomultitask across multiple monitors and applications simultaneously
• Advanced keyboarding skills, with the ability to type quickly and accurately
• Behavioral and Work Style Requirements
• Proven ability to work in afast-paced, high-production, metrics-driven environment
• Strong attention to detail while maintaining speed and accuracy
• Ability to learn quickly and work independently with limited guidance
• Strong time management and organizational skills in a remote setting
• Ability toremain focused and productive while working independently for full shifts
• Comfortable working in astructured, highly monitored environment with performance metrics
• Strong written and verbal communication skills, including the ability to clearly articulate clinical information and medication names
• Ability toreceive, apply, and act on real-time feedback

Preferred Qualifications

• 3+ years of prior authorization experience
• Experience in a specialty medical office or with specialty medications
• Broad clinical background across multiple disease states
• Previous call center or high-volume clinical processing experience

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.