Licensed Vocational Nurse (Prior Authorization)

SGS_JOB_2359

Nursing
Remote
LVN
Licensed Vocational Nurse
Prior Authorization
PBM
Pharmacy Benefit Management

Contract - 06+ Months

Shift: Training Period: First 8 weeks – no time off or vacations allowed Shift Range: Between 8:00 AM – 8:00 PM CST Weekend Requirement: Candidates must work one weekend day (either Sunday–Thursday or Tuesday–Saturday) This position is a 100% remote, work from home opportunity and will not be patient facing however need LVN with Prior Authorization experience.

Job Responsibilities:

  • Review complex clinical criteria-based prior authorizations (electronically and/or in written format) in accordance with policies and procedures and per the health plan/employer agreed criteria.
  • Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
  • Shift priorities while exhibiting a high level of urgency and responsiveness with all calls, prior authorization requests, and ADHOC assignments.
  • Follow all prior authorization procedures to meet business quality standards and ensure the operational unit is complying with regulatory requirements and accreditation standards.
  • Participates in quality assurance activities on ongoing basis, including but not limited to reviewing work instructions and job aids regularly.
  • Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members.
  • Complete other prior authorization assignments as delegated by the leadership team.
  • Utilization of clinical and problem-solving skills to support the research of documentation, communication of medical services, and prior authorization determinations.
  • Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment.
  • This position involves sedentary work with extended periods of sitting, talking on the telephone, using multiple programs on multiple computer screens, and keyboarding.
  • Must have regular and predictable attendance.
  • Colleague will be required to work overtime/work weekends when business requires.

Skills:

  • Hold and maintain an active, unencumbered LPN/LVN license in the state of practice.
  • Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows-based computer applications, web-based processing and telephony programs.
  • Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM).

Education/Experience:

  • The Licensed Practical Nurse is a graduate of a school of Practical Nursing, approved by the State Agency and/or accredited by the National League for Nursing Accrediting Commission (NLNAC) at the time the program was completed by the applicant. The LPN must have a full, active, and unrestricted license as a Licensed Practical in a State, Territory or Commonwealth of the United States or District of Columbia.

Related Jobs

Nurse Practitioner

Nursing
 North Carolina
06+ Months Extendable

Location : Fuquay Varina, North Carolina. Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning.

Nurse Practitioner
NP
FNP
Family Nurse Practitioner

Clinical Care LVN/ LPN Float

Nursing
 North Carolina
06+ Months Extendable

Location : Mooresville, NC Shift: This is a full-time contingent position, 32-40 hours per week including every other weekend, and may require floating to other nearby locations. Dress Code: Nursing Attire Nurses whose experience is primarily in long-term care settings such as nursing homes, home health, LTACs, and skilled nursing facilities may encounter challenges adapting to the clinic environment. Common areas of difficulty include managing multiple simultaneous tasks, limited exposure to standard immunization protocols, and unfamiliarity with navigating the EPIC electronic health record system.

LPN
LVN
Licensed Practical Nurse
Licensed Vocational Nurse

Clinical Care LVN/ LPN Float

Nursing
 North Carolina
06+ Months Extendable

Location : Hickory, NC Shift: This is a full-time contingent position, 32-40 hours per week including every other weekend, and may require floating to other nearby locations. Dress Code: Nursing Attire Nurses whose experience is primarily in long-term care settings such as nursing homes, home health, LTACs, and skilled nursing facilities may encounter challenges adapting to the clinic environment. Common areas of difficulty include managing multiple simultaneous tasks, limited exposure to standard immunization protocols, and unfamiliarity with navigating the EPIC electronic health record system.

LPN
LVN
Licensed Practical Nurse
Licensed Vocational Nurse

Clinical Care LVN/ LPN Float

Nursing
 North Carolina
06+ Months Extendable

Location : Huntersville, NC Shift: This is a full-time contingent position, 32-40 hours per week including every other weekend, and may require floating to other nearby locations. Dress Code: Nursing Attire Nurses whose experience is primarily in long-term care settings such as nursing homes, home health, LTACs, and skilled nursing facilities may encounter challenges adapting to the clinic environment. Common areas of difficulty include managing multiple simultaneous tasks, limited exposure to standard immunization protocols, and unfamiliarity with navigating the EPIC electronic health record system.

LPN
LVN
Licensed Practical Nurse
Licensed Vocational Nurse

Contingent Clinical Care LVN/LPN Float - MC

Nursing
 Georgia
03+ Months Extendable

Location : Roswell, GA 30075 Shift: This is a full-time contingent position, 32-40 hours per week including every other weekend, and may require floating to other nearby locations. Dress Code: Nursing Attire Nurses whose experience is primarily in long-term care settings such as nursing homes, home health, LTACs, and skilled nursing facilities may encounter challenges adapting to the clinic environment. Common areas of difficulty include managing multiple simultaneous tasks, limited exposure to standard immunization protocols, and unfamiliarity with navigating the EPIC electronic health record system.

LPN
LVN
Licensed Practical Nurse
Licensed Vocational Nurse

Family Nurse Practitioner Virtual Care

Nursing
Remote
06+ Months Extendable

Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning. PRN Shift Requirements: • One 8-hour shift per week (up to 40 hours if desired/volume permits) • Two weekends (Sat & Sun) per 6-week cycle • One on call day (or additional pick up) per 6-week cycle • One major holiday • One minor holiday • Shift times are between 6am-11pm - can be flexible based on half/partial shifts Full-time requirements: • 8- or 10-hour shift 4 days a week • every other weekend • multiple shift times available • 1 minor holiday • 2 major holidays

Nurse Practitioner
NP
FNP
Family Nurse Practitioner
Long term Care
Hospital
Clinic
Emergency Room
Patient Care

Nurse Practitioner

Nursing
 Tennessee
06+ Months

Location : Tallahassee, FL 32304 Nurse Practitioners will work in collaboration with a dedicated clinical care team to provide evidenced-based care to a panel of patients. The clinical care team will work with the provider daily to drive better outcomes for entire panel of patients. This will include accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning

Nurse Practitioner
NP
FNP
Family Nurse Practitioner
Long term Care
Hospital
Clinic
Emergency Room
Patient Care

LVN/LPN Float (SA00103814)

Nursing
 Minnesota
4-5 Months

Location: Minneapolis, MN The LVN/LPN will handle patient registration, intake, and wait room support, along with clinical duties such as phlebotomy, specimen collection, immunizations, vitals, EKGs, and retinopathy testing. Candidates must have prior immunization experience. Those with backgrounds limited to long-term care settings (nursing homes, home health, LTACs, SNFs) should not be submitted due to challenges adapting to the environment.

LVN/LPN Float (SA00103815)

Nursing
 Virginia
4-5 Months

Location: South Riding, VA The LVN/LPN will handle patient registration, intake, and wait room support, along with clinical duties such as phlebotomy, specimen collection, immunizations, vitals, EKGs, and retinopathy testing. Candidates must have prior immunization experience. Those with backgrounds limited to long-term care settings (nursing homes, home health, LTACs, SNFs) should not be submitted due to challenges adapting to the environment.

logo

At SGS Consulting, we go beyond resume-job matches, creating meaningful connections and pathways for individuals to thrive in defining careers.


2025. All right reserved.
logologologologo