Licensed Vocational Nurse

Top Skills:
Active unrestricted LPN/LVN license
Minimum 6 months[s] [/s]prior authorization experience
Prior appeals experience is preferred
PBM, specialty pharmacy, payer, or medical office (MDO) experience

RAMP Timeline:
Target Last Offer Date: 11/09/2026
Target Last Acceptance Date: 11/12/2026
Must clear prior to: 11/27/2026

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
Must have prior authorization experience in an MDO, PBM, or clinical setting

Candidate Questionnaire to be included on resume:
-This is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA compliant work area away from distractions. Do you have a separate workspace with no interruptions
-Do you have any conflicts with the training schedule, or have any time off planned during the assignment duration
- Do you have wired internet meeting 25mbps min download and 3mbps minimum upload speed
-You must be able to sit and focus on work for the duration of shift. Are you able to sit and focus with no interruptions for entire shift
The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) will provide processing and communication of Commercial Prior Authorizations (PA) and Appeals reviewed by the Commercial PA and Appeals team for Pharmacy benefits. Reporting to the Pharmacy Operations Manager, working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status. You will also oversee fax processing and providing telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and determinations, and making follow-up phone calls. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.
- Review criteria-based prior authorizations/appeals following policy and procedure
- Provide internal nurse support to the PA/Appeals team and member services department Refer cases not meeting clinical criteria to the Pharmacist and MD team(s).
- Shift priorities while exhibiting a high level of urgency with all calls and assignments.
- Excellent verbal and written skills.
- You will work with pharmacists, other clinical colleagues, healthcare professionals and members.
- Follow all prior authorization and appeals procedures to guarantee an accurate process on each prior authorization.
- Train and mentor representatives on the PA/Appeals team. Complete other PA/Appeals assignments as delegated by the PA/Appeals leadership team.
- Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations
- Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment
- This position involves sedentary work with periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
- Position requires proficiency with computer skills which include navigating multiple systems and keyboarding
- Excellent communication skills, both written and verbal
- Must have regular and predictable attendance

Duties
Manage inbound and outbound calls while maintainingproductivity, quality, and service level expectations
Review and process complex prior authorization and appeals requests using clinical criteria and supporting documentation
Navigatemultiple systems, tools, and communication platforms simultaneouslywith 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
Demonstratecritical thinking and problem-solving when information is unclear or incomplete
Apply internal workflows, job aids, and policies correctly and consistently
Adapt quickly tochanging 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
Maintainattention to detail while processing high volumes of work efficiently
Participate in quality assurance activities and apply feedback for continuous improvement
Perform work in asedentary, desk-based environmentrequiring prolonged sitting, typing, and screen time
Maintain consistent attendance, productivity, and adherence to scheduled work hours

Experience
Active, unrestricted LPN/LVN license
Minimum2%2B years of recent prior authorization experiencein 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.

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 ahigh-volume, metrics-driven environmentwhile maintaining strong clinical judgment, accuracy, and efficiency.
Successful candidates areself-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 requiringa high level of accountability, focus, and independence throughout the entire shift.

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

What days & hours will the person work in this position List training hours, if different.
Training-M-F 8am-4:30pm CT/permanent schedule: Shifts M-F between 8:00am-7:00pm CT.