LPN/LVN Prior Authorization Specialist

Job Summary

To support the processing of specialty medication Prior Authorization requests, the full-time LPN/LVN Prior Authorization Specialist will work remotely, managing inbound calls, processing cases, and maintaining documentation while collaborating with healthcare professionals and members.

Key responsibilities

• Process and communicate specialty medication Prior Authorization requests, including managing inbound calls and electronic authorizations
• Maintain complete and accurate documentation through data entry and reporting, ensuring compliance with established policies
• Review criteria-based Prior Authorizations and refer cases that do not meet clinical criteria to the appropriate medical team

Required qualifications

• Active and unrestricted LPN/LVN license
• High School Diploma or equivalent
• Minimum of 1 year of clinical nursing experience
• Experience in Prior Authorization processing and review
• Demonstrated ability to work in a HIPAA-compliant remote environment