Licensed Practical/Vocational Nurse (LPN/LVN)

• Manage inbound and outbound calls while maintaining productivity, quality, and service level expectations
• Review and process complex prior authorization and appeals requests using clinical criteria and supporting documentation
• Navigate multiple systems, tools, and communication platforms simultaneously with speed and accuracy
• Review chart notes, claims history, and prior authorization history to make accurate determinations
• Submit complete and accurate documentation to support determinations and avoid unnecessary delays
• Identify cases requiring escalation and refer appropriately
• Demonstrate critical thinking and problem-solving when information is unclear or incomplete
• Apply internal workflows, job aids, and policies correctly and consistently
• Adapt quickly to changing priorities, processes, and clinical criteria
• Communicate clearly and professionally with team members, pharmacists, providers, and leadership
• Ask questions and seek clarification when needed to ensure accuracy
• Maintain attention to detail while processing high volumes of work efficiently
• Participate in quality assurance activities and apply feedback for continuous improvement
• Perform work in a sedentary, desk-based environment requiring prolonged sitting, typing, and screen time
• Maintain consistent attendance, productivity, and adherence to scheduled work hours
   

Prescreen Requirements 

• Submit prescreen answers along with resume- for all questions 
• Provide internet speed and service type  
• Must be able to hardwire PC into modem/router 
• Submit copy of active LPN/LVN license with expiration date 
• Must have prior authorization experience in an MDO, PBM, or clinical setting
   

Top Skills:

• Active unrestricted LPN/LVN license
• Minimum 6 months[s] [/s]prior authorization experience
• Prior appeals experience is preferred
• PBM, specialty pharmacy, payer, or medical office (MDO) experience