California Licensed Prior Authorization Nurse

Job Summary

To support a leading managed care organization, the remote California Licensed Prior Authorization Nurse will manage specialty medication prior authorization requests, communicate with healthcare professionals and prescribers, and maintain accurate documentation while working in a contract role.

Key responsibilities

• Review criteria-based prior authorizations following established policies and procedures
• Provide on-call after-hours nurse availability for urgent prior authorization requests
• Train and mentor representatives on the prior authorization team

Required qualifications

• Active, unrestricted LPN or LVN license in the candidate's state of residence or a valid compact license
• Minimum 2 years of clinical experience as an LPN/LVN
• Prior authorization experience in an MDO, PBM, or clinical setting
• Experience in managed care, health plan, payer, PBM, or utilization management environments preferred
• Ability to work independently in a fully remote environment