LPN/LVN – Prior Authorization

Position details:
Position: LPN/LVN – Prior Authorization
Location: Fully Remote
Contract: 6 Months (Highly possibilities of extension)
Hours: 38 - 40 hours/week
Training Schedule: 8:00 Am to 4:30 Pm CST (Mon - Fri)
Training is expected to last approximately 5 weeks.
Permanent Schedule: Between 8:00 Am – 5:00 Pm CST (Mon - Fri)
Shifts are expected to be approximately eight hours per day and may include one weekend day per week
Position Summary
We are seeking experienced LPN/LVN professionals with recent prior authorization experience in a specialty medical office (MDO), pharmacy benefit manager (PBM), or clinical setting.
The LPN/LVN Prior Authorization Specialist will review and process complex prior authorization requests, evaluate clinical documentation against applicable criteria, communicate with providers and other healthcare professionals, and ensure accurate and timely processing of authorization cases.
This is a fully remote, high-volume, metrics-driven position requiring strong clinical judgment, attention to detail, productivity, adaptability, and the ability to work independently in a highly structured environment.
Responsibility:
Manage inbound and outbound calls while meeting productivity, quality, and service-level expectations.
Review and process complex prior authorization requests using clinical criteria and supporting documentation.
Review chart notes, claims history, prior authorization history, and insurance requirements.
Submit complete and accurate documentation to support authorization determinations and prevent unnecessary delays.
Identify cases requiring escalation and refer them appropriately.
Apply clinical criteria, internal workflows, policies, and job aids consistently.
Demonstrate critical thinking and problem-solving when information is incomplete or unclear.
Navigate multiple systems, applications, and communication platforms simultaneously while maintaining accuracy and efficiency.
Communicate clearly and professionally with pharmacists, providers, team members, and leadership.
Ask appropriate questions and seek clarification when needed to ensure accurate processing.
Maintain a high level of attention to detail while processing a high volume of cases.
Participate in quality assurance activities and apply coaching and feedback for continuous improvement.
Adapt quickly to changes in workflows, processes, medications, and clinical criteria.
Maintain consistent attendance, productivity, and adherence to assigned work hours.
Work effectively in a sedentary, desk-based environment requiring prolonged sitting, typing, screen time, and phone use.
Required Qualification:
Active, unrestricted LPN/LVN license
Minimum 2 years of recent, hands-on prior authorization experience in a PBM, MDO, or clinical setting.
Experience with CoverMyMeds or a similar prior authorization platform.
Experience reviewing and applying clinical criteria and supporting documentation for prior authorization requests.
Ability to accurately communicate and document clinical information and medication names.
Familiarity with chart notes, claims history, medication information, and insurance requirements.
Education:
Graduate of an accredited Practical/Vocational Nursing program approved by the applicable state agency and/or accredited by NLNAC or equivalent

Work arrangement
Yes