Job ID: 26-87262
Position Type: Full time
Location: Remote
Work Type: Remote
Est. Pay Range: $26.00/hr. to $28.50/hr. all-inclusive on W2
Position Summary:
- We are seeking experienced LPN/LVN candidates with prior authorization experience in a specialty medical office (MDO), PBM, or clinical setting.
- This role requires the ability to work in a high-volume, metrics-driven environment while maintaining strong clinical judgment, accuracy, and efficiency.
- Successful candidates are self-directed, resourceful, and adaptable, with the ability to quickly interpret clinical information, navigate multiple systems simultaneously, and maintain productivity while managing competing priorities.
- This is a fully remote role requiring a high level of accountability, focus, and independence throughout the entire shift.
Permanent Schedule:
- Schedules are assigned based on business needs and may include:
- Sunday–Thursday or Tuesday–Saturday
- Shifts between 10:00 AM–6:30 PM CST
- Schedule flexibility, overtime, and weekend availability are required.
Duties:
- 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
Experience:
- 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
- Fully remote position requiring a quiet, dedicated, distraction-free workspace
- Position involves extended periods of desk-based work, including screen time, keyboarding, and phone use
Education
- Graduate of an accredited school of Practical Nursing (NLNAC or equivalent)
- Must maintain active licensure in good standing
Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
