NEW JOB OPENING
LICENSED VOCATIONAL NURSE
IN Remote, USA!

Required Education

• High School Diploma



Required License

• Active unrestricted LPN/LVN license in state of residence or Compact License



Required Qualifications / Skills / Experience

• Minimum 2 years clinical experience as an LPN/LVN

• Prior Authorization experience experience

• Managed Care, Health Plan, PBM, Utilization Management, or Payer experience

• Experience handling inbound and outbound calls

• Experience working in a high-volume production environment

• Strong multitasking and organizational skills

• Experience using Microsoft Office and Windows-based applications

• Digital charting experience

• Strong verbal and written communication skills

• Ability to navigate multiple systems simultaneously

• Strong documentation and data entry skills

• Ability to prioritize and adapt in a fast-paced environment

• Call center experience



Preferred Qualifications / Skills / Experience

• Pharmacy benefit prior authorization experience

• Prior remote work experience

• Case Management experience

• Utilization Management experience



Licensed Vocational Nurse (LPN/LVN) Overview

• Provides processing and communication support for Commercial Pharmacy Prior Authorizations in a remote work environment

• Reviews and processes authorization requests according to established policies and procedures

• Supports communication between physician offices, pharmacies, members, customer service, and pharmacy operations teams

• Handles inbound and outbound phone calls related to authorization requests, status updates, and issue resolution

• Maintains accurate documentation, case processing, authorization loading, and reporting activities

• Collaborates with pharmacists, clinicians, healthcare providers, and internal teams to facilitate authorization determinations

• Refers cases that do not meet established criteria to pharmacists and physicians for clinical review

• Operates within a high-volume production environment with required productivity and quality metrics

• Utilizes clinical knowledge, strong organizational skills, and attention to detail to ensure accurate and timely processing

• Requires the ability to manage multiple priorities while delivering excellent customer service and maintaining compliance standards



Job Duties

• Review criteria-based prior authorizations following established policies and procedures

• Process and communicate Commercial Pharmacy Prior Authorization determinations

• Support internal prior authorization and member services teams

• Refer cases requiring clinical review to pharmacists and physicians

• Handle inbound and outbound phone calls with providers, pharmacies, patients, and internal teams

• Process authorizations and maintain accurate documentation

• Load authorizations into system applications

• Conduct follow-up calls regarding authorization requests and case status

• Communicate referral and authorization status to physician offices and internal departments

• Perform data entry, reporting, and case management activities

• Maintain compliance with prior authorization procedures and quality standards

• Participate in training sessions and departmental meetings

• Complete additional projects and assignments as requested

• **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.**