LPN/LVN Prior Authorization Specialist#26-36379

$15.15-$25.98 per hour

Remote, RI

Remote

Job Description

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

ious 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.