LPN Prior Authorization Specialist

Job Summary

Supporting the processing of commercial pharmacy benefit prior authorizations and appeals, the full-time Licensed Practical Nurse (LPN) Prior Authorization Specialist will work remotely to review requests, document case information, communicate referral statuses, and provide assistance to prescriber offices, pharmacies, and members.

Key responsibilities

• Manage inbound and outbound calls while ensuring productivity and quality standards are met
• Review and process prior authorization and appeals requests using clinical criteria and supporting documentation
• Maintain accurate case documentation and communicate referral status updates to relevant stakeholders

Required qualifications

• Active LPN/LVN license in the state of residence
• High school diploma or equivalent
• Minimum of 2 years of prior authorization experience in a medical office or pharmacy benefit management
• Experience reviewing clinical information and processing prior authorizations
• Proficiency in navigating multiple computer systems and tools