Remote LPN Prior Authorization Specialist

not applicable; United States; À distance; USD 37 000 - 40 000; Plein temps

Résumé du poste

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.

Qualifications

• 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.

Responsabilités

• 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.

Connaissances

LPN/LVN license

Prior authorization

Multitasking

Attention to detail

Remote work

High-volume environment

Phone calls

Clinical criteria

Communication

Formation

LPN/LVN license

Outils

CoverMyMeds

Description du poste

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.