Licensed Practical Nurse - Remote

Position: Licensed Vocational Nurse

Location: Fully remote (never coming onsite)

Duration: 12+ months (with higher possibilities of extension)

Shift Schedule: Training-M-F 8am-4:30pm CT/permanent schedule: Shifts M-F between 8:00am-7:00pm CT.

Position Summary:

We are seeking experienced LPN/LVN candidates with prior authorization experience in a specialty medical office (MDO), PBM, or clinical setting. This role requires the ability to work in a high-volume, metrics-driven environment while maintaining strong clinical judgment, accuracy, and efficiency.

Successful candidates are self-directed, resourceful, and adaptable, with the ability to quickly interpret clinical information, navigate multiple systems simultaneously, and maintain productivity while managing competing priorities. This is a fully remote role requiring a high level of accountability, focus, and independence throughout the entire shift.

Duties

• Manage inbound and outbound calls while maintaining productivity, quality, and service level expectations
• Review and process complex prior authorization and appeals requests using clinical criteria and supporting documentation
• Navigate multiple systems, tools, and communication platforms simultaneously with speed and accuracy
• Review chart notes, claims history, and prior authorization history to make accurate determinations
• Submit complete and accurate documentation to support determinations and avoid unnecessary delays
• Identify cases requiring escalation and refer appropriately
• Demonstrate critical thinking and problem-solving when information is unclear or incomplete
• Apply internal workflows, job aids, and policies correctly and consistently
• Adapt quickly to changing priorities, processes, and clinical criteria
• Communicate clearly and professionally with team members, pharmacists, providers, and leadership
• Ask questions and seek clarification when needed to ensure accuracy
• Maintain attention to detail while processing high volumes of work efficiently
• Participate in quality assurance activities and apply feedback for continuous improvement
• Perform work in a sedentary, desk-based environment requiring prolonged sitting, typing, and screen time
• Maintain consistent attendance, productivity, and adherence to scheduled work hours

Experience

• Active, unrestricted LPN/LVN license
• Minimum 2+ years of recent prior authorization experience in a PBM, MDO, or clinical setting
• Experience reviewing and applying clinical criteria and supporting documentation for Pas
• Experience using CoverMyMeds or similar authorization platforms
• Familiarity with chart notes, claims history, and insurance requirements
• Licensed as an LPN in the state in which they reside.

Education

• Graduate of an accredited school of Practical Nursing (NLNAC or equivalent)
• Must maintain active licensure in good standing