Remote LPN: Prior Authorization Specialist

Randstad USA; United States; Remote; USD 36,000 - 39,000; Full time

Job summary

Randstad USA is hiring a Licensed Practical Nurse/Licensed Vocational Nurse to support the Commercial Prior Authorization team. This 100% remote, non-patient-facing role processes and communicates prior authorization requests and determinations with physicians, pharmacies, and members.

You’ll work closely with healthcare professionals to meet productivity and quality targets while maintaining strict documentation standards and cross-team collaboration from a home office.

Qualifications

• Active, unrestricted LPN or LVN license in the candidate's state of residence or a valid compact license.
• Minimum 2 years of clinical experience as an LPN/LVN.
• Recent Prior Authorization experience, preferably involving pharmacy benefits.
• Experience in managed care, health plan, payer, PBM, or utilization management environments preferred.
• Experience working in a high-volume, metrics-driven healthcare environment.
• Strong ability to prioritize, assess situations quickly, manage multiple tasks, and adapt to changing priorities.
• Experience with Microsoft Office and Windows-based computer applications.
• Ability to navigate multiple computer systems simultaneously.
• Experience with digital charting and electronic clinical documentation.
• Strong written and verbal communication skills.
• Excellent organizational skills and strong attention to detail.
• Ability to work independently in a fully remote environment.
• Ability to maintain regular and predictable attendance.

Responsibilities

• Review criteria-based prior authorization requests in accordance with established policies and procedures.
• Process and document Commercial Pharmacy Prior Authorization cases accurately and efficiently.
• Provide clinical and operational support to the Prior Authorization and Member Services teams.
• Refer cases that do not meet established clinical criteria to the appropriate Pharmacist and/or Medical Director team.
• Process faxes, authorization requests, and related documentation.
• Load and maintain authorizations within applicable systems.
• Handle inbound and outbound calls with prescriber offices, pharmacies, healthcare providers, members, technicians, and internal teams.
• Respond to inquiries and facilitate prior authorization requests with a focus on first-call resolution when applicable.
• Make follow-up calls regarding authorization requests and case status.
• Utilize clinical knowledge to support documentation and communication of medical services and prior authorization determinations.
• Maintain complete, accurate, and timely documentation in applicable systems.
• Perform computer system data entry, data management, and reporting activities.
• Collaborate with pharmacists, nurses, healthcare professionals, and other clinical and operational colleagues.
• Shift priorities as needed while maintaining a high level of urgency and accuracy.
• Meet established productivity, quality, and performance metrics.
• Multitask effectively and adapt to a fast-paced, continuously changing environment.
• Attend required training sessions, development meetings, and team activities.
• Perform other related duties and projects as assigned by PA leadership.

Skills

2+ years clinical experience

Remote/telesales capable

Strong written and verbal comms

Ability to multitask

Independent remote worker

Prior Authorization experience

Microsoft Office proficiency

Education

Active LPN/LVN license (unrestricted)

Tools

Electronic charting / EHR

Windows OS & MS Office

Job description

Randstad USA is hiring a Licensed Practical Nurse/Licensed Vocational Nurse to support the Commercial Prior Authorization team. This 100% remote, non-patient-facing role processes and communicates prior authorization requests and determinations with physicians, pharmacies, and members.

You’ll work closely with healthcare professionals to meet productivity and quality targets while maintaining strict documentation standards and cross-team collaboration from a home office.