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Posted 9 days ago
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Requirements and responsibilities
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.
- 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. This is a fully remote role requiring a high level of accountability, focus, and independence throughout the entire shift.
Schedule:
Training Schedule:
- Monday–Friday, 8:00 AM–4:30 PM CST.
- Training duration: 8 weeks (may extend due to holidays).
Permanent Schedule:
- Schedules are assigned based on business needs and may include:
- Sunday–Thursday or Tuesday–Saturday.
- Shifts between 10:00 AM–6:30 PM CST.
- Schedule flexibility, overtime, and weekend availability are required.
Duties:
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.
- 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.
Experience:
Required Qualifications:
- 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.
Technical Skills:
- 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.
Preferred Qualifications:
- 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:
- Successful team members consistently demonstrate:
- 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.
Work Environment & Expectations:
- Fully remote position requiring a quiet, dedicated, distraction-free workspace.
- Position involves extended periods of desk-based work, including screen time, keyboarding, and phone use.
- Continuous performance tracking, including:
- Productivity.
- Quality.
- Adherence.
- Candidates must be comfortable working in a highly structured, closely monitored environment.
- Ability to troubleshoot minor technical issues independently, partner with IT as needed, and maintain accountability for timely follow-up and resolution of system issues.
Education:
- Graduate of an accredited school of Practical Nursing (NLNAC or equivalent).
- Must maintain active licensure in good standing.
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