Remote Prior Authorization LVN/LPN {177290}

Job Description

Job Description

Remote Prior Authorization LVN/LPN

Location: Remote (United States)
Type: W2 Contract (Temporary) | Hours: 40/week
Pay Rate: $26.00/hr

Overview

We’re seeking an experienced LVN/LPN to support a high-volume Prior Authorization (PA) and Appeals team for pharmacy benefits. This is a fully remote role that requires strong attention to detail, comfort navigating multiple systems, and consistent productivity in a metrics-driven environment.

Schedule

• Training: Monday–Friday, 8:00 AM – 4:30 PM CT
• Post-training schedule: Monday–Friday, shifts scheduled between 8:00 AM – 7:00 PM CT

Key Responsibilities

• Process and communicate Commercial Prior Authorizations and Appeals
• Manage inbound/outbound calls while meeting productivity and quality expectations
• Review clinical criteria and supporting documentation (chart notes, claims history, PA history)
• Document determinations accurately and completely
• Escalate cases that require pharmacist/MD review per guidelines
• Work effectively across multiple systems/tools with speed and accuracy

Required Qualifications

• Active, unrestricted LVN/LPN license (in the state where you reside)
• 2+ years of recent prior authorization experience in a PBM, medical office (MDO), or clinical setting
• Experience applying clinical criteria and supporting documentation for PA decisions
• Strong written/verbal communication and ability to adapt in a fast-paced environment

Preferred:

• Appeals experience
• PBM / specialty pharmacy / payer experience
• Experience with CoverMyMeds (or similar platforms)

Remote / Technical Requirements

• Dedicated, HIPAA-compliant workspace (private area, minimal distractions)
• Wired internet required (minimum 25 Mbps download / 3 Mbps upload )
• Must be able to hardwire the provided PC directly to modem/router

Prescreen Questions (please answer with your application)

1. Do you have a separate workspace with no interruptions for your full shift?
2. Do you have any conflicts with the training schedule or planned time off during the assignment?
3. Do you have wired internet meeting 25 Mbps down / 3 Mbps up ?
4. Are you able to sit and focus with no interruptions for the full shift?

Benefits

Benefits may be available to eligible full-time employees after 90 days . A 401(k) with company match may be available after 1 year of service.

Interested?

Austin Faris
Phone: View phone number on us.fitly.work