Call Center LPN

Job Description

Job Description

1. General Purpose of the Job

To support patients and the clinical team by managing phone calls, medication refill requests and coordinating medication prior authorizations. This role serves as a clinical liaison between patients, pharmacies, providers, and insurance companies to ensure timely access to prescribed medications while maintaining compliance with regulatory and organizational standards. The Call Center LPN Representative provides clinical support by managing and coordinating incoming triage and nursing-specific calls. This role identifies patient concerns using established protocols , provides appropriate nursing guidance within scope of practice, and ensures timely escalation to providers or registered nurses as needed. The LPN serves as a key point of contact to promote patient safety, continuity of care, and positive patient experiences.

1. Essential Duties & Responsibilities

1. Receive incoming calls related to medication refill requests;
2. Review patient records to verify eligibility, dosage, and refill timing;
3. Process refill requests per provider protocols and clinical guidelines;
4. Communicate with pharmacies and providers to clarify or resolve refill issues;
5. Educate patients on refill processes, medication adherence, and timelines
6. Initiate, submit, and track medication prior authorizations with insurance payers;
7. Collect and document required clinical information to support authorization requests;
8. Communicate authorizations tatus to patients, providers, and pharmacies;
9. Follow up on pending or denied authorizations and escalate as appropriate;
10. Maintain accurate documentation in electronic health record (EHR)
11. Receive and assess incoming patient calls related to symptoms, clinical concerns, and care questions
12. Perform nursing triage using approved protocols, standing orders, and clinical guidelines;
13. Identify urgent or emergent conditions and escalate appropriately to RNs, providers, or emergency services;
14. Provide patient education and nursing guidance within LPN scope of practice;
15. Provide clear empathetic communication to patients via phone and electronic messaging;
16. Collaborate with physicians, nurses, medical assistants, and administrative staff;
17. Address patient concerns related to medication access and insurance requirements;
18. Ensure adherence to HIPAA, state nursing regulations, and organizational policies;
19. Accurately document all interactions, actions ,and outcomes in the EHR;
20. Meet productivity, quality, and customer service benchmarks;
21. Clinical judgment within scope of practice;
22. Patient safety and advocacy;
23. Time management and organization;
24. Maintain clear and honest documentation;
25. Collaborate and communicate effectively and efficiently on a team level;

1. Supervisory Responsibilities

None

1. Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Education and/or Experience

Associate's degree (A. A.) or equivalent from two-year college or technical school and one to six months' related experience and/or training; or equivalent combination of education and experience.

New York State licensure as a Licensed Practical Nurse. Certified in CPR.

1. Necessary Skills & Abilities

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills

To perform this job successfully, an individual should have basic to intermediate knowledge of Microsoft Office software (Outlook, Excel, Word), as well as Practice Management and Electronic Medical Record software.

1. Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk; sit; reach with hands and arms; stoop, kneel, crouch, or crawl and taste or smell. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and ability to adjust focus.

1. Travel

This job may require you to travel depending upon scheduling needs.

1. Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

May come into contact with human blood or other potentially infectious materials, which may result in possible exposure to blood borne pathogens (Category 1)