LPN/LVN Prior Authorization Specialist

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.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities