Remote Prior Authorization LVN

Remote Prior Authorization LVN/LPN Location: Remote (United States) Type: W2 Contract (Temporary) | Hours: 40/week Pay Rate: $26.00/hr

Overview

We're seeking an experienced LVN/LPN to support a high-volume Prior Authorization (PA) and Appeals team for pharmacy benefits. This is a fully remote role that requires strong attention to detail, comfort navigating multiple systems, and consistent productivity in a metrics-driven environment.

Schedule Training: Monday-Friday, 8:00 AM - 4:30 PM CT Post-training schedule: Monday-Friday, shifts scheduled between 8:00 AM - 7:00 PM CT

Key Responsibilities

• Process and communicate Commercial Prior Authorizations and Appeals
• Manage inbound/outbound calls while meeting productivity and quality expectations
• Review clinical criteria and supporting documentation (chart notes, claims history, PA history)
• Document determinations accurately and completely
• Escalate cases that require pharmacist/MD review per guidelines
• Work effectively across multiple systems/tools with speed and accuracy

Required Qualifications

• Active, unrestricted LVN/LPN license (in the state where you reside)
• 2+ years of recent prior authorization experience in a PBM, medical office (MDO), or clinical setting
• Experience applying clinical criteria and supporting documentation for PA decisions
• Strong written/verbal communication and ability to adapt in a fast-paced environment

Preferred

• Appeals experience PBM / specialty pharmacy / payer experience
• Experience with CoverMyMeds (or similar platforms)

Remote / Technical Requirements

• Dedicated, HIPAA-compliant workspace (private area, minimal distractions)
• Wired internet required (minimum 25 Mbps download / 3 Mbps upload)
• Must be able to hardwire the provided PC directly to modem/router

Prescreen Questions (please answer with your application)

• Do you have a separate workspace with no interruptions for your full shift?
• Do you have any conflicts with the training schedule or planned time off during the assignment?
• Do you have wired internet meeting 25 Mbps down / 3 Mbps up?
• Are you able to sit and focus with no interruptions for the full shift?

Benefits

Benefits may be available to eligible full-time employees after 90 days. A 401(k) with company match may be available after 1 year of service.