We are seeking experienced LPN/LVN candidates with prior authorization experience in a specialty medical office (MDO), PBM, or clinical setting.
This role requires the ability to work in a high-volume, metrics-driven environment while maintaining strong clinical judgment, accuracy, and efficiency.
Successful candidates are self-directed, resourceful, and adaptable, with the ability to quickly interpret clinical information, navigate multiple systems simultaneously, and maintain productivity while managing competing priorities.
This is a fully remote role requiring a high level of accountability, focus, and independence throughout the entire shift
Job Responsibilities
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
Numbers & Facts
Location
(Remote)
Job Type
Temporary, Full-time
Salary
$27.50 Per Hour
Company Size
51 - 200
Year Founded
null
Headquarters
Princeton, NJ, US
Website
https://sgsconsulting.com/
Qualifications
Active, unrestricted LPN/LVN license
Minimum 2+ years of recent prior authorization experience in a PBM, MDO, or clinical setting
Experience reviewing and applying clinical criteria and supporting documentation for PAs
Experience using CoverMyMeds or similar authorization platforms
Familiarity with chart notes, claims history, and insurance requirements
Licensed as an LPN in the state in which they reside
Graduate of an accredited school of Practical Nursing (NLNAC or equivalent)