NEW JOB OPENING
PRIOR AUTHORIZATION LICENSED VOCATIONAL NURSE (LPN-LVN)
IN Remote, USA!

Required Education:

• Graduate of an accredited school of Practical Nursing (NLNAC or equivalent)



Required License/Certification:

• Active, unrestricted LPN/LVN license in good standing



Required Qualifications/Skills/Experience

• Minimum 2 years of recent prior authorization experience in a PBM, specialty medical office, or clinical setting

• Experience reviewing and applying clinical criteria and supporting documentation for prior authorizations

• Experience using CoverMyMeds or similar electronic authorization platforms

• Familiarity with chart notes, claims history, prior authorization history, and insurance requirements

• Strong computer proficiency with Outlook, Teams, Word, Excel, and related applications

• Ability to work across multiple systems and monitors simultaneously

• Advanced keyboarding and data entry skills

• Ability to work in a fast-paced, metrics-driven environment

• Strong attention to detail and accuracy

• Ability to work independently with minimal supervision

• Strong time management and organizational skills

• Excellent verbal and written communication skills

• Ability to accept and apply real-time feedback

• Ability to maintain productivity while working remotely

• Ability to hardwire equipment to a modem/router

• Ability to provide internet speed and service information

• Completion of a computer skills assessment



Preferred Qualifications/Skills/Experience

• 3 years of prior authorization experience

• Experience with specialty medications

• Experience in a specialty medical office environment

• Broad clinical background across multiple disease states

• Previous call center experience

• High-volume clinical processing experience



Prior Authorization Licensed Vocational Nurse (LPN/LVN) Overview:

• We are seeking experienced Licensed Practical Nurses/Licensed Vocational Nurses with prior authorization experience in a Pharmacy Benefit Management, specialty medical office, or clinical setting

• This fully remote role requires strong clinical judgment, attention to detail, and the ability to thrive in a high-volume, metrics-driven environment

• The ideal candidate is resourceful, self-directed, and capable of navigating multiple systems while efficiently processing prior authorization requests

• Responsibilities include reviewing clinical documentation, claims history, and authorization criteria to support accurate determinations while maintaining productivity and quality standards

• Candidates must be comfortable working independently in a structured environment with continuous performance monitoring

• Successful team members demonstrate accountability, adaptability, critical thinking, and strong communication skills

• This role requires multitasking across various systems, managing inbound and outbound communications, and maintaining accuracy under pressure

• Candidates should possess excellent organizational skills and the ability to quickly learn new medications, disease states, and clinical criteria

• This position offers comprehensive training and provides an opportunity to support patients and providers through timely and accurate prior authorization processing while working from a dedicated home office environment



Job Duties:

• Manage inbound and outbound calls while maintaining productivity and service standards

• Review and process complex prior authorization requests

• Apply clinical criteria and supporting documentation to make accurate determinations

• Navigate multiple systems and communication platforms simultaneously

• Review chart notes, claims history, and prior authorization history

• Submit complete and accurate documentation

• Escalate cases appropriately when necessary

• Demonstrate critical thinking and problem-solving skills

• Follow internal workflows, job aids, and policies

• Adapt to changing priorities and clinical criteria

• Communicate professionally with pharmacists, providers, team members, and leadership

• Participate in quality assurance activities and implement feedback

• Maintain productivity, quality, and schedule adherence metrics

• Work in a sedentary, desk-based environment requiring prolonged sitting, keyboarding, and screen time

• Troubleshoot minor technical issues and coordinate with IT support when necessary



Estimated Start Date:

• August 16, 2026

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**