Responsibilities include answering inbound phone calls, processing cases and electronic authorizations, loading authorizations, and making follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards. 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 following policy and procedure.
· Provide on-call after hours nurse availability for urgent PA requests.
· Provide internal nurse support to the PA 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 procedures to guarantee an accurate process on each prior authorization.
· Complete other PA assignments as delegated by the PA leadership team.

Duties
You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the client Specialty Medical Prior Authorization department. Reporting to the Pharmacy Operations Manager, you will work with physician office staff and customer service, admissions and pharmacy operations departments to communicate prior authorization status. You will also oversee fax processing and provide 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.

Experience
1+ years prior clinical work experience
Excellent interpersonal skills
Demonstrated problems solving ability and attention to detail
Ability to work effectively in a team environment with great dependability
Excellent oral and written communication skills
Ability to quickly assess and adapt to constantly changing situations, phone and PC use
Required to possess a high mental agility and alertness
Ability to effectively communicate with pharmacists, other clinical colleagues, healthcare professionals and members
Ability to effectively prioritize work while exhibiting a high level of urgency with all calls and assignments
Ability to effectively train and mentor representatives on the PA team

Position Summary
Review criteria-based prior authorizations following policy and procedure
Provide on-call after hours nurse availability for urgent PA requests
Provide internal nurse support to the PA 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 procedures to guarantee an accurate process on each prior authorization.
Complete other PA assignments as delegated by the PA leadership team.

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

“Registered Nurses (RNs) not accepted for LVN/LPN roles unless otherwise stated”


Notes:
40 hours
Fully remote (never coming onsite)
Training schedule is approximately 5 weeks starting 11/16/2025, Monday to Friday 8:00am - 4:30pm CST, Expected shifts to be 8 hours per day, which may also include one weekend day per week.
Training is M-F 8am-4:30pm CST for 5 weeks then M-F: 8am-5 pm CST.