NOW HIRING: Remote Clinical Review LPN/LVN
Location: 100% Remote (Work from Anywhere in the U.S.)
Pay: $26.00/hour
Schedule:
Training (8 weeks):
Monday-Friday
8:00 AM-4:30 PM CST
After Training:
Sunday-Thursday or Tuesday-Saturday
10:00 AM-6:30 PM CST
Remote
Responsibilities:
• Review and process prior authorization requests using clinical criteria
• Evaluate medical records, chart notes, lab results, surgical reports, discharge summaries, claims history, and medication history
• Make accurate clinical determinations based on established guidelines
• Document decisions clearly and accurately
• Manage inbound and outbound calls as needed
• Navigate multiple computer systems and authorization platforms simultaneously
• Escalate complex cases when appropriate
• Maintain productivity, quality, and accuracy goals
• Communicate professionally with providers, pharmacists, and internal teams
• Stay up to date on changing clinical guidelines and workflows
Qualifications:
• Active, unrestricted LPN/LVN license in state of residence
• At least 2 years of recent prior authorization experience
• Experience working in one or more of the following:
Pharmacy Benefit Manager (PBM)
Specialty Medical Office
Health Plan
Private Medical Office
Durable Medical Equipment (DME) Prior Authorizations
Treatment, Imaging, Procedure, or Surgical Authorizations
• Experience reviewing clinical documentation and applying prior authorization criteria in one or all of the following:
Clinical chart notes
Lab results
Claims history
Medication criteria
Insurance requirements
• Experience using CoverMyMeds or similar prior authorization software preferred
• Comfortable working in a high-volume, metrics-driven remote environment
Benefits:
Life Insurance, 401K Match, Medical, Dental, Vision
Skills:
Licensed Practical Nurse/Licensed Vocational Nurse, Telehealth, Managed Care, Patient Care Authorizations, CLINICAL REVIEW, Utilization Management, UTILIZATION REVIEW
About the Company:
A-Line Staffing Solutions
A-Line Staffing Solutions is a premier staffing company that supplies professionals to the Healthcare, Insurance, Pharmaceutical, and Information Technology industries.
Founded in 2004, A-Line Staffing Solutions has been a leader in matching talented individuals to the jobs that our clients NEED to fill. We are experts at offering creative staffing solutions to employers, and we are hiring every day.
A-Line Staffing can offer short-term, long-term and direct-hire opportunities to professionals across the United States. We hire only the most qualified and talented individuals in the country. Our recruiting, selection and stringent screening processes have strengthened our reputation for delivering quality customer service and unbeatable talent.
For our commissioned clients, A-Line Staffing closely follows the standards and practices established by The Joint Commission. For all of our clients and employees, our commitment to continual improvement combined with a strict code of ethics provides an atmosphere of respect and unparalleled professionalism.
To find out how A-Line Staffing Solutions can share our talent with you, please contact us today. We are eager to include you among our most valued and satisfied clients. If you are a professional and would like to learn more about open opportunities in your area, please contact us today. We are always searching for talented and enthusiastic professionals
Industry:
Staffing/Employment Agencies
Headquarters:
Utica, MI, US
Founded:
2004