Remote LPN reviewing and processing prior authorization requests using clinical criteria in a high-volume, metrics-driven environment. Must be comfortable with inbound/outbound calls, multi-system navigation, and fast-paced case resolution.
Remote
Responsibilities:
Review prior authorization requests against clinical guidelines
Make medical necessity determinations; escalate complex cases
Manage inbound/outbound calls and correspondence with providers
Navigate multiple systems (CoverMyMeds, Outlook, Teams, Excel)
Maintain accurate documentation and meet quality/compliance standards
Adapt to shifting priorities with urgency
Qualifications:
Active, unrestricted LPN/LVN license
2+ years recent prior authorization experience in PBM, MDO, or clinical setting
Remote experience in high-volume environment
Strong computer proficiency (Outlook, Teams, Word, Excel)
CoverMyMeds or similar platform experience
Ability to hardwire PC; internet speed: 25/3 mbps
Excellent communication and keyboarding skills
Benefits:
Employee Referral Program
Skills:
prior authorization, Licensed Practical Nurse/Licensed Vocational Nurse, Metrics, Patient Care Authorizations
About the Company:
Managed staffing
Leading healthcare solutions company reaching millions through local presence, digital channels, and 300,000+ colleagues. Committed to transforming healthcare access and outcomes.