NEW JOB OPENING
LPN/ LVN-PRIOR AUTHORIZATION SPECIALIST REMOTE
IN Remote, USA!

Required Education:

• High School Diploma or Equivalent

• Graduate of a Practical or Vocational Nursing program approved by the applicable state agency and/or accredited by the National League for Nursing



Required License/Certification:

• Active, and unrestricted LPN/LVN license



Required Qualifications/Skills/Experience:

• 1+ year of prior clinical work experience

• Strong interpersonal, verbal, and written communication skills

• Demonstrated problem-solving ability and attention to detail

• Ability to work effectively in a team environment with strong dependability

• Ability to quickly assess and adapt to changing situations while using phone and computer systems

• Ability to effectively communicate with pharmacists, clinical colleagues, healthcare professionals, and members

• Ability to prioritize work while maintaining a high level of urgency

• Ability to provide processing and communication support for specialty medication Prior Authorization requests

• Ability to process inbound calls, fax requests, electronic authorizations, and follow-up calls

• Ability to maintain complete and accurate documentation

• Ability to work independently in a fully remote environment

• Ability to work in a HIPAA-compliant workspace away from distractions

• Private internet service with a minimum of 25 Mbps download and 3 Mbps upload

• Ability to provide an internet speed test screenshot with the resume

• Ability to work 40 hours per week

• Ability to participate in required training and assigned production schedule

• Ability to support mandatory weekend coverage as required



Preferred Qualifications/Skills/Experience:

• Experience with specialty medication Prior Authorization workflows

• Experience working with physician office staff, pharmacies, members, healthcare professionals, and internal clinical teams

• Experience training or mentoring representatives on a Prior Authorization team

• Experience with after-hours or urgent Prior Authorization support

• Experience working in a remote healthcare environment



LPN/LVN – Prior Authorization Specialist | Remote Overview:

• The LPN/LVN – Specialty Medication Prior Authorization role supports the processing and communication of specialty medication Prior Authorization requests in a fully remote healthcare environment

• The LPN/LVN will work with physician office staff, customer service teams, admissions, pharmacy operations, pharmacists, healthcare professionals, and members to communicate Prior Authorization status and support timely case resolution

• The position involves answering inbound calls, processing Prior Authorization cases and electronic authorizations, managing fax requests, loading authorizations, and completing follow-up calls using courteous and professional communication

• The LPN/LVN is responsible for maintaining complete and accurate documentation through computer system data entry, data management, and reporting

• The role requires reviewing criteria-based Prior Authorizations according to established policies and procedures, identifying cases that do not meet clinical criteria, and referring those cases to the appropriate Pharmacist or medical team

• The LPN/LVN may also provide internal support to the Prior Authorization and member services teams, assist with urgent requests, and complete additional PA assignments as delegated by leadership

• Candidates must have a full, active, and unrestricted LPN/LVN license and be able to work effectively in a secure, HIPAA-compliant home environment. Candidates located in the Mountain or Pacific time zones are preferred



Job Duties:

• Process and communicate specialty medication Prior Authorization requests

• Answer inbound calls from physician office staff, pharmacies, members, and other healthcare professionals

• Process Prior Authorization cases, electronic authorizations, and fax requests

• Load authorizations and complete follow-up calls

• Review criteria-based Prior Authorizations according to established policies and procedures

• Maintain complete, timely, and accurate documentation of all required information

• Perform computer system data entry, data management, and reporting

• Provide after-hours nurse availability for urgent Prior Authorization requests as required

• Provide internal nurse support to the Prior Authorization and member services teams

• Refer cases that do not meet clinical criteria to the Pharmacist and medical team

• Work with pharmacists, clinical colleagues, healthcare professionals, and members

• Shift priorities while maintaining a high level of urgency with calls and assignments

• Follow established Prior Authorization procedures to support accurate processing

• Train and mentor representatives on the Prior Authorization team as needed

• Complete other Prior Authorization assignments delegated by leadership

• **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.**