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Posted 29 days ago
Requirements and responsibilities
Job Title: LPN/LVN - Prior Authorization
Duration: 4 plus month with possible extension
Location: Fully Remote
Pay Range: $26- $28.00/hr
Position Summary
We are seeking experienced LPN/LVN candidates with prior authorization experience in a specialty medical office (MDO), PBM, or clinical setting.
This role requires the ability to work in a high-volume, metrics-driven environment while maintaining strong clinical judgment, accuracy, and efficiency.
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
Key Responsibilities
• 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.