Remote LPN: Prior Authorization Specialist

A-Line Staffing Solutions; Woonsocket (RI); On-site; USD 52,000 - 72,000; Full time

Benefits offered by this job

Benefits after 90 days

401(k) with match

Job summary

A-Line Staffing Solutions is seeking an experienced Licensed Vocational Nurse (LPN/LVN) for remote work in the United States. The role focuses on processing and communicating Commercial Pharmacy prior authorizations, reviewing criteria, and escalating cases to pharmacists and MDs as needed.

You will handle calls, document information accurately, and support the communication of medical services and determinations.

Qualifications

• Minimum 2 years clinical experience as a LPN/LVN.
• Unrestricted license in state of residence or compact license.
• Relevant nursing certifications/licenses related to nursing.

Responsibilities

• Process and communicate Commercial Prior Authorizations for Pharmacy benefits.
• Review criteria-based prior authorizations following policy and procedure.
• Refer cases not meeting clinical criteria to Pharmacist/MD teams and escalate as needed.
• Handle inbound/outbound calls to facilitate prior authorization requests and inquiries.
• Document all necessary information accurately using computer systems.
• Support documentation and communication of medical services and prior authorization determinations.
• Assist in fax processing and provide telephone assistance for prescriber staff, pharmacies, and members.

Skills

LPN/LVN experience

Telephone handling

Education

LPN/LVN license

Compact license

Job description

A-Line Staffing Solutions is seeking an experienced Licensed Vocational Nurse (LPN/LVN) for remote work in the United States. The role focuses on processing and communicating Commercial Pharmacy prior authorizations, reviewing criteria, and escalating cases to pharmacists and MDs as needed.

You will handle calls, document information accurately, and support the communication of medical services and determinations.