Role overview

Qualifications

Active, unrestricted LPN/LVN license
Minimum 2+ years of recent prior authorization experience in a PBM, MDO, or clinical setting
Experience reviewing and applying clinical criteria and supporting documentation for PAs
Experience using CoverMyMeds or similar authorization platforms

Responsibilities

Manage inbound and outbound calls while maintaining productivity, quality, and service level expectations
Review and process complex prior authorization requests using clinical criteria and supporting documentation
Navigate multiple systems, tools, and communication platforms simultaneously with speed and accuracy
Communicate clearly and professionally with team members, pharmacists, providers, and leadership

Key facts

Remote from: Rhode Island (USA)
Full time
Mid-level (2-5 years)
Nurse
English

Hard skills

Nurse Licensure Compact Prior Authorization Clinical Assessments Pharmacy Experience Call Center Experience Clinical Medicine

Other skills

Critical Thinking
Detail Oriented
Computer Literacy
Multitasking
Computer Keyboards
Organizational Skills
Communication
Time Management
Problem Solving

About the company

ICONMA

Management Consulting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge

IndustryManagement Consulting

Company size1001 - 5000

Links

Website LinkedIn See all jobs

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Job description

Our Client, a Retail Pharmacy company, is looking for a Licensed Vocational Nurse-LPN for their Remote location.

Responsibilities:

Manage inbound and outbound calls while maintaining productivity, quality, and service level expectations
Review and process complex prior authorization requests using clinical criteria and supporting documentation
Navigate multiple systems, tools, and communication platforms simultaneously with 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
Demonstrate critical thinking and problem-solving when information is unclear or incomplete
Apply internal workflows, job aids, and policies correctly and consistently
Adapt quickly to changing 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
Maintain attention to detail while processing high volumes of work efficiently
Participate in quality assurance activities and apply feedback for continuous improvement
Perform work in a sedentary, desk-based environment requiring prolonged sitting, typing, and screen time
Maintain consistent attendance, productivity, and adherence to scheduled work hours

Requirements:

Active, unrestricted LPN/LVN license
Minimum 2+ years of recent prior authorization experience in 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
Technical Skills
Strong computer proficiency across multiple systems (Outlook, Teams, Word, Excel, etc.)
Ability to multitask across multiple monitors and applications simultaneously
Advanced keyboarding skills, with the ability to type quickly and accurately
Behavioral and Work Style Requirements
Proven ability to work in a fast-paced, high-production, metrics-driven environment
Strong attention to detail while maintaining speed and accuracy
Ability to learn quickly and work independently with limited guidance
Strong time management and organizational skills in a remote setting
Ability to remain focused and productive while working independently for full shifts
Comfortable working in a structured, highly monitored environment with performance metrics
Strong written and verbal communication skills, including the ability to clearly articulate clinical information and medication names
Ability to receive, apply, and act on real-time feedback
Preferred Qualifications
3+ years of prior authorization experience
Experience in a specialty medical office or with specialty medications
Broad clinical background across multiple disease states
Previous call center or high-volume clinical processing experience
What Makes Someone Successful in This Role
Successful team members consistently demonstrate:
Ability to work under pressure while maintaining accuracy and productivity
Demonstrated ownership, reliability, and accountability for performance
Resourcefulness—able to locate and interpret information independently before escalating
Confidence to ask questions, seek clarification, and speak up when unsure
Ability to quickly learn new medications, disease states, and clinical criteria
Strong multitasking ability across systems, workflows, and communication tools
Excellent attention to detail combined with processing speed
Resilience and adaptability—able to adjust to frequent changes and challenges
Ability to remain focused and productive despite obstacles, system issues, or changing priorities
Ability to work successfully within a structured, performance-driven environment
Strong self-awareness and coachability, including the ability to accept and apply feedback
Accountability for personal performance, learning, and development
Ability to work independently in a distraction-free remote environment
Work Environment & Expectations

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities