Licensed Practical Nurse LPN - Remote | WFH

This fully remote position offers a work-from-home opportunity with no patient-facing responsibilities. You will undergo approximately three weeks of training from Monday to Friday, 8:00 am - 4:30 pm CST. Post-training, your schedule will include 8-hour shifts Monday through Friday, between 8:00 am CST and 12:00 am CST, with potential weekend requirements.

Responsibilities

Reporting to the Pharmacy Operations Manager, you will handle specialty medication prior authorization (PA) requests for the Caremark Specialty Medical Prior Authorization department. Your role involves:

Processing and communicating PA requests with physician office staff, customer service admissions, and pharmacy operations departments.

Overseeing fax processing and providing telephone support to prescriber office staff, pharmacies, and members based on program criteria.

Answering inbound phone calls, processing cases, and managing electronic authorizations with a courteous and professional demeanor.

Ensuring complete and accurate documentation through computer system data entry, data management, and reporting.

Following policy and procedure for criteria-based prior authorizations.

Providing on-call after-hours nurse availability for urgent PA requests.

Supporting the PA team and member services department internally.

Referring cases not meeting clinical criteria to Pharmacist and MD teams.

Prioritizing tasks with a high sense of urgency and maintaining excellent verbal and written communication skills.

Training and mentoring PA team representatives as delegated by PA leadership.

Requirements

High School Diploma or GED required.

Minimum 1-3 Years Of Relevant Experience.

Ability to manage diverse customer interactions with confidence and professionalism.

Proficiency in Microsoft Office Suite (Excel, Word, Access), with ability to navigate Windows and web-based applications.

Strong organizational skills with attention to detail and ability to prioritize tasks effectively.

Problem-solving ability and commitment to maintaining confidentiality.

Knowledge of claim eligibility processes is preferred.

Collaborative team player with strong interpersonal skills.

Additional Information

This role requires a HIPAA-compliant work environment free from distractions, with secure private internet service (minimum 25mbps download/3mbps upload) to support remote work duties effectively.

Employment Type: Full-Time