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Licensed Vocational Nurse

Integrated Resources, Inc

Woonsocket, RI

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JOB DETAILS
JOB TYPE
Contractor
SKILLS
Call Centers, Case Management, Clinical Competency, Clinical Medicine, Clinical Support, Communication Skills, Computer Skills, Computer Systems, Customer Support/Service, Data Entry, Data Management, Detail Oriented, Documentation, Establish Priorities, Health Plan, Healthcare, Healthcare Providers, Licensed Practical Nurse/Licensed Vocational Nurse, Managed Care, Medical Office, Metrics, Microsoft Office, Microsoft Windows Operating System, Multitasking, Nursing, Operational Communications, Operations Management, Organizational Skills, Patient Care Authorizations, Pharmacy, Presentation/Verbal Skills, Support Documentation, Telephone Skills, Typing, Writing Skills
LOCATION
Woonsocket, RI
POSTED
22 days ago
Summary: Anywhere in the USA opportunity and will not be patient facing. The Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits. This is a high production role with required metrics. Position Summary: The Licensed Practical Nurse (LPN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits. Reporting to the Pharmacy Operations Manager, working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status. You will also oversee fax processing and providing telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and making follow-up phone calls. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting. Duties: Review criteria-based prior authorizations following policy and procedure Provide internal nurse support to the PA team and member services department Refer cases not meeting clinical criteria to the Pharmacist and MD team(s). Shift priorities while exhibiting a high level of urgency with all calls and assignments. You will work with pharmacists, other clinical colleagues, healthcare professionals and members. Follow all prior authorization procedures to guarantee an accurate process on each prior authorization. Complete other PA assignments as delegated by the PA leadership team. Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment This position involves sedentary work with periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer. Position requires proficiency with computer skills which include navigating multiple systems and keyboarding Excellent communication skills, both written and verbal Must have regular and predictable attendance Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve calls with a one call solution. Performs other related projects and duties as assigned, including attending training sessions and development meetings. Experience: Minimum 2 years clinical experience as a LPN/LVN. A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license. Prior authorization experience or Case Management experience 3+ years prior related clinical work experience Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations. Experience using MS Office and other Windows-based computer applications and phone use. Digital charting Managed care or health plan previous experience, Call center experience Multi-tasking experience Case Management experience Prior authorization experience High production experience Excellent organizational skills. Strong detail orientation. SAFTEY SENSITIVE ROLE **At the top of the resume, please include screenshots of the following: Candidates internet speed test Active LPN/LVN license Completed presubmission questionnaire Completed computer literacy assessment scores; please have candidate complete a computer literacy assessment. Ramp Timeline: Last Offer Extended - May 24, 2026 Last Acceptance Target - May 26 May 28, 2026 Last Day to Clear - June 11, 2026 **Work Schedule & Training Requirements: Please review carefully before submitting candidates: - Work Hours: Work hours will vary between 8:00 AM 8:00 PM Central Time (CT). Candidates must be able and willing to work Central Time hours, regardless of where they reside in the U.S. - Training: Training duration: 6 weeks Training hours: 8:00 AM 4:30 PM CT, MondayFriday Training attendance is mandatory and must be worked in full during these hours. - Overtime: Overtime is required based on business needs - Candidates must be flexible and able to work OT when requested. Position Summary: The Licensed Practical Nurse (LPN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits. Reporting to the Pharmacy Operations Manager, working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status. You will also oversee fax processing and providing telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and making follow-up phone calls. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting. Duties: Duties: Review criteria-based prior authorizations following policy and procedure Provide internal nurse support to the PA team and member services department Refer cases not meeting clinical criteria to the Pharmacist and MD team(s). Shift priorities while exhibiting a high level of urgency with all calls and assignments. You will work with pharmacists, other clinical colleagues, healthcare professionals and members. Follow all prior authorization procedures to guarantee an accurate process on each prior authorization. Complete other PA assignments as delegated by the PA leadership team. Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment This position involves sedentary work with periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer. Position requires proficiency with computer skills which include navigating multiple systems and keyboarding Excellent communication skills, both written and verbal Must have regular and predictable attendance Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve calls with a one call solution. Performs other related projects and duties as assigned, including attending training sessions and development meetings. Experience: Minimum 2 years clinical experience as a LPN/LVN. A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license. Prior authorization experience or Case Management experience 3+ years prior related clinical work experience Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations. Experience using MS Office and other Windows-based computer applications and phone use. Digital charting Managed care or health plan previous experience, Call center experience Multi-tasking experience Case Management experience Prior authorization experience High production experience Excellent organizational skills. Strong detail orientation. Education: Minimum 2 years clinical experience as a LPN/LVN. A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license.

About the Company

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Integrated Resources, Inc