Licensed Vocational Nurse

Description:
Client MAX Bill Rate: *** Supplier

SAFETY

Questionnaire:
Make sure candidate location is at top of resume Please include screenshot of speed test at top of resume.
-How much experience to they have with Prior Authorization in an MDO or clinical setting? and make sure this is present on their resume under each position they have the experience with.
-What is their current availability for work schedule?
-Need a screenshot of their active and unencumbered LVN / LPN license at the top of the resume.

Schedule Training: Mon - Fri, 8:00 AM - 4:30 PM CST Starting 11/10/2025. Training will be 8 weeks. Potential candidates need to be available during this time. We don t recommend trainee s miss anymore than 8 hours of training.

Permanent Shift Range: Work week will be 5 days a week; could include weekdays and weekends. Shift time will be set based on business needs. Shifts may range between 8am - 8pm CST (8 hours shift)

Prescreen include with Resume: Internet Speed and Copy of LPN Candidates MUST HAVE prior authorization experience in an MDO or a clinical setting. Please make sure this is clear on their resumes.

This position is a 100% remote, work from home opportunity and will not be patient facing.

Provide processing and communication of Specialty medication prior authorization (PA) referrals reviewed by the Commercial Specialty Guideline Management Programs for the Pharmacy and Medical benefits. You will be 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 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.

Position Summary
Prescreen (include with resume): Internet speed and copy of LPN/LVN license with expiration date.
Candidates MUST HAVE prior authorization experience in an MDO, PBM, or a clinical setting.
Schedule: For training there is a set schedule 8am-430pm CST Monday-Friday. Following training, they will have a permanent schedule. Shift range varies and are subject to change.
Shift range: Sunday Saturday 8:00 AM 6:00 PM. New hires will be expected to work a weekend shift ongoing as part of their permanent schedule rotation (Sunday-Thursday or Tuesday-Saturday).

Review complex clinical criteria-based prior authorizations (electronically and/or in written format) in accordance with Client/Caremark policies and procedures and per the health plan/employer agreed criteria.
Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
Must possess excellent communication skills, both written and verbal.
Shift priorities while exhibiting a high level of urgency and responsiveness with all calls, prior authorization requests, and ADHOC assignments.
Follow all prior authorization procedures to meet business quality standards and ensuring the operational unit is complying with regulatory requirements and accreditation standards.
Participates in quality assurance activities on ongoing basis, including but not limited to reviewing work instructions and job aids regularly.
Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members.
Complete other prior authorization assignments as delegated by the leadership team.
Utilization of clinical and problem-solving skills to support the research of documentation, 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 extended periods of sitting, talking on the telephone, using multiple programs on multiple computer screens, and keyboarding.
Must have regular and predictable attendance.
Colleague will be required to work business required overtime/work weekends when business requires.

Required Qualifications
Hold and maintain an active, unencumbered LPN/LVN license in the state of practice.
Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows-based computer applications, web based processing and telephony programs.
Minimum 2 years recent experience reviewing and processing prior authorizations aProductst health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM).

Preferred Qualifications
3+ years prior work experience as an LPN/LVN in a specialty medical office, skilled clinical setting and/or PBM.

Education
The Licensed Practical Nurse is a graduate of a school of Practical 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 must have a full, active, and unrestricted license as a Licensed Practical in a State, Territory or Commonwealth of the United States or District of Columbia.

Timeline & Key Dates
- Start Date: November 10, 2025
- Target Offer Date: October 13, 2025
- Clearance Deadline: October 31, 2025 (all candidates must be cleared by Halloween)


Licensing & Screening
- License Validity: Must not expire within the first 90 days of employment

Training & Shifts
- Training Period: First 8 weeks no time off or vacations allowed
- Shift Range: Between 8:00 AM 8:00 PM CST
- Weekend Requirement: Candidates must work one weekend day (either Sunday Thursday or Tuesday Saturday)
- Shift Preferences: Will be collected via a form post-hire; optional to list on resume


Remote Work
- Location Flexibility: Fully remote; candidates can reside anywhere as long as they meet shift requirements

Additional Notes
- Candidate Requirements: Must be LPNs with prior authorization experience

Position Summary:

Position Summary
Prescreen (include with resume): Internet speed and copy of LPN/LVN license with expiration date.
Candidates MUST HAVE prior authorization experience in an MDO, PBM, or a clinical setting.
Schedule: For training there is a set schedule 8am-430pm CST Monday-Friday. Following training, they will have a permanent schedule. Shift range varies and are subject to change.
Shift range: Sunday Saturday 8:00 AM 6:00 PM. New hires will be expected to work a weekend shift ongoing as part of their permanent schedule rotation (Sunday-Thursday or Tuesday-Saturday).

Review complex clinical criteria-based prior authorizations (electronically and/or in written format) in accordance with Client/Caremark policies and procedures and per the health plan/employer agreed criteria.
Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
Must possess excellent communication skills, both written and verbal.
Shift priorities while exhibiting a high level of urgency and responsiveness with all calls, prior authorization requests, and ADHOC assignments.
Follow all prior authorization procedures to meet business quality standards and ensuring the operational unit is complying with regulatory requirements and accreditation standards.
Participates in quality assurance activities on ongoing basis, including but not limited to reviewing work instructions and job aids regularly.
Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members.
Complete other prior authorization assignments as delegated by the leadership team.
Utilization of clinical and problem-solving skills to support the research of documentation, 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 extended periods of sitting, talking on the telephone, using multiple programs on multiple computer screens, and keyboarding.
Must have regular and predictable attendance.
Colleague will be required to work business required overtime/work weekends when business requires.

Required Qualifications
Hold and maintain an active, unencumbered LPN/LVN license in the state of practice.
Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows-based computer applications, web based processing and telephony programs.
Minimum 2 years recent experience reviewing and processing prior authorizations aProductst health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM).

Preferred Qualifications
3+ years prior work experience as an LPN/LVN in a specialty medical office, skilled clinical setting and/or PBM.

Education
The Licensed Practical Nurse is a graduate of a school of Practical 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 must have a full, active, and unrestricted license as a Licensed Practical in a State, Territory or Commonwealth of the United States or District of Columbia.

Duties:

Review complex clinical criteria-based prior authorizations (electronically and/or in written format) in accordance with Client/Caremark policies and procedures and per the health plan/employer agreed criteria.
Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
Must possess excellent communication skills, both written and verbal.
Shift priorities while exhibiting a high level of urgency and responsiveness with all calls, prior authorization requests, and ADHOC assignments.
Follow all prior authorization procedures to meet business quality standards and ensuring the operational unit is complying with regulatory requirements and accreditation standards.
Participates in quality assurance activities on ongoing basis, including but not limited to reviewing work instructions and job aids regularly.
Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members.
Complete other prior authorization assignments as delegated by the leadership team.
Utilization of clinical and problem-solving skills to support the research of documentation, 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 extended periods of sitting, talking on the telephone, using multiple programs on multiple computer screens, and keyboarding.
Must have regular and predictable attendance.
Colleague will be required to work business required overtime/work weekends when business requires.

Experience:

Required Qualifications
Hold and maintain an active, unencumbered LPN/LVN license in the state of practice.
Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows-based computer applications, web based processing and telephony programs.
Minimum 2 years recent experience reviewing and processing prior authorizations aProductst health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM).

Preferred Qualifications
3+ years prior work experience as an LPN/LVN in a specialty medical office, skilled clinical setting and/or PBM.

Education
The Licensed Practical Nurse is a graduate of a school of Practical 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 must have a full, active, and unrestricted license as a Licensed Practical in a State, Territory or Commonwealth of the United States or District of Columbia.

Education:

Education
The Licensed Practical Nurse is a graduate of a school of Practical 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 must have a full, active, and unrestricted license as a Licensed Practical in a State, Territory or Commonwealth of the United States or District of Columbia.