Licensed Vocational Nurse-LPN# 26-14906
US Tech Solutions · Rhode Island, United States · 2 wk ago
RemoteRemoteHealthcareFull-time
Position Summary
Seeking experienced LPN/LVN professionals with at least 2 years of recent Prior Authorization (PA) experience in a PBM, Specialty Medical Office (MDO), Health Plan, or Clinical Setting. This is a fully remote, high-volume, metrics-driven role requiring strong clinical judgment, attention to detail, and the ability to work independently.
Required Qualifications
- Active, unrestricted LPN/LVN license
- Minimum 2+ years of recent Prior Authorization experience
- Experience reviewing:
- Clinical criteria
- Chart notes
- Claims history
- Prior authorization history
- Supporting clinical documentation
- Experience with CoverMyMeds or similar PA platforms
- Familiarity with insurance requirements and authorization processes
Key Responsibilities
- Process and review prior authorization requests
- Review clinical documentation and apply authorization criteria
- Handle inbound and outbound provider/member calls
- Document determinations accurately and efficiently
- Navigate multiple systems simultaneously
- Escalate complex cases when appropriate
- Meet productivity, quality, and adherence metrics
- Collaborate with pharmacists, providers, and internal teams
Required Skills
- Prior Authorization Processing
- Clinical Documentation Review
- CoverMyMeds
- Chart Review
- Claims Review
- Insurance Authorization Requirements
- Microsoft Outlook, Teams, Word, Excel
- Multitasking across multiple screens
- Strong keyboarding/data entry skills
- Critical Thinking
- Attention to Detail
- Time Management
Preferred Qualifications
- 3+ years of Prior Authorization experience
- PBM experience
- Specialty medication experience
- Specialty Medical Office experience
- Call center experience
- High-volume clinical processing experience
- Broad disease-state knowledge
About US Tech Solutions
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com. US Tech Solutions is an Equal Opportunity Employer.