Duration: 6 contracts
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. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.
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