Role Description Our client, a Retail Pharmacy company, is looking for a LPN/LVN Prior Authorization Specialist for their Remote location.

• 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.

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.
• 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.

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.
• Previous call center or high-volume clinical processing experience.

Benefits

• Health Benefits.
• Referral Program.
• Excellent growth and advancement opportunities.