Our client, a Retail Pharmacy company, is looking for a LPN/LVN Prior Authorization Specialist for their Remote location.
Responsibilities:
This role requires the ability to work in a high-volume, metrics-driven environment while maintaining strong clinical judgment, accuracy, and efficiency.
Manage inbound and outbound calls while maintaining productivity, quality, and service level expectations
Review and process complex prior authorization 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
Requirements:
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.
Strong computer proficiency across multiple systems (Outlook, Teams, Word, Excel, etc.)
Ability to multitask across multiple monitors and applications simultaneously
Advanced keyboarding skills, with the ability to type quickly and accurately
Behavioral and Work Style Requirements
Proven ability to work in a fast-paced, high-production, metrics-driven environment
Strong attention to detail while maintaining speed and accuracy
Ability to learn quickly and work independently with limited guidance
Strong time management and organizational skills in a remote setting
Ability to remain focused and productive while working independently for full shifts
Comfortable working in a structured, highly monitored environment with performance metrics
Strong written and verbal communication skills, including the ability to clearly articulate clinical information and medication names
Ability to receive, apply, and act on real-time feedback
3+ years of prior authorization experience
Experience in a specialty medical office or with specialty medications
Broad clinical background across multiple disease states
Previous call center or high-volume clinical processing experience
What Makes Someone Successful in This Role
Ability to work under pressure while maintaining accuracy and productivity
Demonstrated ownership, reliability, and accountability for performance
Resourcefulness-able to locate and interpret information independently before escalating
Confidence to ask questions, seek clarification, and speak up when unsure
Ability to quickly learn new medications, disease states, and clinical criteria
Strong multitasking ability across systems, workflows, and communication tools
Excellent attention to detail combined with processing speed
Resilience and adaptability-able to adjust to frequent changes and challenges
Ability to remain focused and productive despite obstacles, system issues, or changing priorities
Ability to work successfully within a structured, performance-driven environment
Strong self-awareness and coachability, including the ability to accept and apply feedback
Accountability for personal performance, learning, and development
Ability to work independently in a distraction-free remote environment
Graduate of an accredited school of Practical Nursing (NLNAC or equivalent)
Must maintain active licensure in good standing
The Licensed Practical Nurse is a graduate of a school of Practical or Vocational Nursing, approved by the State Agency and/or accredited by the National League for Nursing (Accrediting Commission (NLNAC)) at the time the program was completed by the applicant. The LPN/LVN must have a full, active and unrestricted license as a Licensed Practical or Vocational Nurse in a State, Territory or Commonwealth of the United States or District of Columbia.
Registered Nurses (RNs) not accepted for LVN/LPN roles unless otherwise stated
We are seeking experienced LPN/LVN candidates with prior authorization experience in a specialty medical office (MDO), PBM, or clinical setting.
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.