Rhode Island Licensed Vocational Nurse
Job Summary
To support the processing of Commercial Prior Authorizations, the remote Licensed Vocational Nurse will manage communication and documentation for pharmacy benefits, assist with fax processing, and review clinical criteria while working from home in a dedicated workspace.
Key responsibilities
- Provide processing and communication of prior authorizations and appeals for pharmacy benefits
- Review and interpret clinical criteria and documentation related to prior authorizations
- Maintain accurate documentation and escalate cases not meeting clinical criteria as needed
Required qualifications
- Active, unrestricted LPN/LVN license in the state of residence
- Graduate of an accredited Practical Nursing program (NLNAC or equivalent)
- Minimum 2+ years of prior authorization experience in a PBM, MDO, or clinical setting
- Experience with CoverMyMeds or similar authorization platforms
Complete Job Description
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