Licensed Vocational Nurse-LPN

LPN/LVN Position

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 role requiring a high level of accountability, focus, and independence throughout the entire shift.

Prescreen Requirements:

• Submit prescreen answers along with resume- for all questions
• Provide internet speed and service type
• Must be able to hardwire PC into modem/router
• Submit copy of active LPN/LVN license with expiration date
• Submit completed computer skills assessment with resume
• Must have prior authorization experience in an MDO, PBM, or clinical setting

Training

Schedule:

• Monday–Friday, 8:00 AM–4:30 PM CST
• Training duration: 8 weeks (may extend due to holidays)

Permanent

Schedule:

• Schedules are assigned based on business needs and may include:
  Sunday–Thursday or Tuesday–Saturday
• Shifts between 10:00 AM–6:30 PM CST
• Schedule flexibility, overtime, and weekend availability are required.

Key Responsibilities:

• Manage inbound and outbound calls while maintaining productivity, quality, and service level expectations
• Review and process complex prior authorization 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

Required Qualifications:

• 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 Client
• Experience using Cover My Meds  or similar authorization platforms
• Familiarity with chart notes, claims history, and insurance requirements

Technical

Skills:

• Strong computer proficiency across multiple systems (Outlook, Teams, Word, Excel, etc.)
• Ability to multitask across multiple monitors and applications simultaneously
• Advanced keyboarding skills, with the ability to type quickly and accurately

Behavioral and Work Style Requirements:

• Proven ability to work in a fast-paced, high-production, metrics-driven environment
• Strong attention to detail while maintaining speed and accuracy
• Ability to learn quickly and work independently with limited guidance
• Strong time management and organizational skills in a setting
• Ability to remain focused and productive while working independently for full shifts
• Comfortable working in a structured, highly monitored environment with performance metrics
• Strong written and verbal communication skills, including the ability to clearly articulate clinical information and medication names
• Ability to receive, apply, and act on real-time feedback

Preferred Qualifications:

• 3+ years of prior authorization experience
• Experience in a specialty medical office or with specialty medications
• Broad clinical background across multiple disease states
• Previous call center or high-volume clinical processing experience

Education:

The Licensed Practical Nurse is a graduate of a school of Practical or Vocational Nursing, approved by the State Agency and/or accredited by the National League for Nursing (Accrediting Commission (NLNAC)) at the time the program was completed by the applicant. The LPN/LVN must have a full, active and unrestricted license as a Licensed Practical or Vocational Nurse in a State, Territory or Commonwealth of the United States or District of Columbia.