Licensed Vocational Nurse

VIVA USA Inc; United States; À distance; USD 52 000 - 78 000; Plein temps

Résumé du poste

VIVA USA Inc. is seeking an experienced LPN/LVN for a fully remote role focused on processing and communicating Commercial Prior Authorizations (PA) and Appeals for Pharmacy benefits.

Reporting to the Pharmacy Operations Manager, you will support prescribers, pharmacies, and members, handle fax processing, data entry, and reporting, and mentor team members on PA/Appeals procedures.

Qualifications

• Active, unrestricted LPN/LVN license.
• Minimum 2+ years of prior authorization experience in a PBM, MDO, or clinical setting.
• Experience using CoverMyMeds or similar authorization platforms.

Responsabilités

• Manage inbound and outbound calls with productivity and service goals.
• Review and process complex prior authorization and appeals requests using clinical criteria.
• Navigate multiple systems with speed and accuracy to support determinations.
• Submit complete documentation to support determinations and avoid delays.
• Identify cases requiring escalation and refer appropriately.
• Train and mentor representatives on PA/Appeals processes.

Connaissances

LPN/LVN License

Prior Authorization Experience

PBM/Medical Office Experience

Communication Skills

Formation

Practical Nursing Diploma/Certificate

Active licensure in state

Description du poste

Fully remote (never coming onsite)

The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) will provide processing and communication of Commercial Prior Authorizations (PA) and Appeals reviewed by the Commercial PA and Appeals team for Pharmacy benefits. Reporting to the Pharmacy Operations Manager, working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status. You will also oversee fax processing and providing telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and determinations, and making follow-up phone calls. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.

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.

Review criteria-based prior authorizations/appeals following policy and procedure

Provide internal nurse support to the PA/Appeals 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.

Excellent verbal and written skills.

You will work with pharmacists, other clinical colleagues, healthcare professionals and members.

Follow all prior authorization and appeals procedures to guarantee an accurate process on each prior authorization.

Train and mentor representatives on the PA/Appeals team. Complete other PA/Appeals assignments as delegated by the PA/Appeals leadership team.

Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations

Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment

This position involves sedentary work with periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.

Position requires proficiency with computer skills which include navigating multiple systems and keyboarding

Excellent communication skills, both written and verbal

Must have regular and predictable attendance

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.

Top Skills

• Active unrestricted LPN/LVN license
• Minimum 6 months[s] [/s]prior authorization experience
• Prior appeals experience is preferred
• PBM, specialty pharmacy, payer, or medical office (MDO) experience

Education

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

Notes

Fully remote

Training-M-F 8am-4:30pm CT/permanent schedule: Shifts M-F between 8:00am-7:00pm CT.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status