Remote Prior Authorization LVN

Job Summary

Supporting a high-volume Prior Authorization and Appeals team for pharmacy benefits, the full-time Remote Prior Authorization LVN will process and communicate commercial prior authorizations, manage calls, and review clinical criteria while working in a metrics-driven environment.

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, documenting determinations accurately

Required Qualifications

• Active, unrestricted LVN/LPN license in the state of residence
• 2+ years of recent prior authorization experience in a PBM, medical office, or clinical setting
• Experience applying clinical criteria and supporting documentation for PA decisions
• Strong written and verbal communication skills