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Remote Prior Authorization Representative Express Scripts Jobs in Texas

BrightSpring

Clinical Hub Supervisor

Arlington, TX · Remote

Remote opportunity Schedule Monday - Friday, 8:30am - 5:00pm Central Time Zone Requirements include ... prior authorizations. Benefits and perks for You! * Medical, Dental, Vision insurance * Health ...

PharMerica

Clinical Hub Supervisor

Arlington, TX · Remote

Remote opportunity Schedule Monday - Friday, 8:30am - 5:00pm Central Time Zone Requirements include ... prior authorizations. Benefits and perks for You! * Medical, Dental, Vision insurance * Health ...

Pavago

Sales Development Representative

Austin, TX · On-site +1

Sales Development Representative (SDR - Outbound Sales, Lead Generation, Cold Calling - Remote, U.S ... Call scripts * Optimize for: * Reply rates * Conversion rates * Meetings booked CRM & Pipeline ...

Pavago

Sales Development Representative

Austin, TX · Remote

Sales Development Representative (SDR - Outbound Sales, Lead Generation, Cold Calling - Remote, U.S ... Call scripts * Optimize for: * Reply rates * Conversion rates * Meetings booked CRM & Pipeline ...

Pierre Strand

Remote Sales Representative.

Houston, TX · On-site +1

Responsibilities of a Sales Representative: * Proactively identifying and engaging potential ... No prior sales experience is required; we offer comprehensive training to ensure you are fully ...

Pierre Strand

Remote Sales Representative

Houston, TX · On-site +1

Responsibilities of a Sales Representative: * Proactively identifying and engaging potential ... No prior sales experience is required; we offer comprehensive training to ensure you are fully ...

Pierre Strand

Remote Sales Representative

El Paso, TX · On-site +1

Responsibilities of a Sales Representative: * Proactively identifying and engaging potential ... No prior sales experience is required; we offer comprehensive training to ensure you are fully ...

Pierre Strand

Remote Sales Representative

Dallas, TX · On-site +1

Responsibilities of a Sales Representative: * Proactively identifying and engaging potential ... No prior sales experience is required; we offer comprehensive training to ensure you are fully ...

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All JobsRemote Prior Authorization Representative Express Scripts JobsRemote Prior Authorization Representative Express Scripts Jobs in Texas

Remote Prior Authorization Representative Express Scripts information

What is the difference between Remote Prior Authorization Representative Express Scripts vs Remote Claims Processor?

AspectRemote Prior Authorization Representative Express ScriptsRemote Claims Processor
CredentialsHigh school diploma, healthcare certifications often preferredHigh school diploma, healthcare or insurance certifications
Work EnvironmentRemote, healthcare insurance settingRemote, insurance claims processing environment
Employer & IndustryExpress Scripts, healthcare/pharmacy industryVarious insurance companies, healthcare industry
Primary ResponsibilitiesReview and approve prior authorization requestsReview and process insurance claims

The Remote Prior Authorization Representative at Express Scripts focuses on evaluating and approving prior authorization requests for medications, ensuring timely patient access. In contrast, a Remote Claims Processor handles the review and processing of insurance claims after services are rendered. While both roles require healthcare knowledge and remote work skills, their core functions differ in the stages of the insurance process they manage.

What are popular job titles related to Remote Prior Authorization Representative Express Scripts jobs in Texas? For Remote Prior Authorization Representative Express Scripts jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Remote Prior Authorization Representative Express Scripts jobs in Texas look for? The top searched job categories for Remote Prior Authorization Representative Express Scripts jobs in Texas are:
What cities in Texas are hiring for Remote Prior Authorization Representative Express Scripts jobs? Cities in Texas with the most Remote Prior Authorization Representative Express Scripts job openings:
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Infographic showing various Remote Prior Authorization Representative Express Scripts job openings in Texas as of June 2026, with employment types broken down into 71% Full Time, and 29% Part Time. Highlights an 100% Remote job distribution.
Utilization Management LPN

Utilization Management LPN

Allmed Staffing Inc

Pearland, TX • Remote

$40/hr

Other

Medical, Dental, Vision, Retirement

Posted 7 days ago

Key responsibilities

  • Review and process authorization requests, including consults, follow-up visits, and procedures.

  • Ensure accurate and timely documentation within EPIC or similar systems.

  • Communicate authorization decisions and status updates to providers verbally and in writing.

Job description

Job Title: Utilization Management LPN
Allmed Benefits: Vision Insurance, Health Insurance, Dental Insurance and 401(k)
Pay Rate: $40/hr (Paid Weekly)
Work Location: 11511 SHADOW CREEK Pkwy, Pearland, TX
Contract: 05/11/2026 to 08/07/2026
Schedule: Monday – Friday, 8:00 AM – 5:00 PM

Position Overview:

The Utilization Management LPN supports daily utilization management operations by reviewing authorization requests, ensuring timely and accurate processing, and maintaining compliance with health plan and regulatory requirements. This role is essential in supporting workflow efficiency, particularly during periods of increased volume or team coverage needs.

Team Environment:

This position reports to a supervisor and works within a collaborative team of approximately 10–11 members. The team includes licensed nurses and utilization management professionals dedicated to meeting service level agreements, productivity goals, and quality standards in a fast-paced environment.

Key Responsibilities:

  • Review and process authorization requests, including consults, follow-up visits, and procedures
  • Apply medical necessity criteria such as InterQual and evaluate plan benefits
  • Ensure accurate and timely documentation within EPIC or similar systems
  • Communicate authorization decisions and status updates to providers verbally and in writing
  • Maintain compliance with regulatory, quality, and audit requirements
  • Support high-volume work queues and assist with coverage needs
  • Coordinate redirection of services, benefit clarification, and continuity of care
  • Meet established productivity, turnaround time, and quality benchmarks
  • Assist with workflow improvements and departmental goals as needed

Qualifications:

Required:

  • Active LVN/LPN license in a Compact State or Texas
  • Minimum 2 years of clinical experience, preferably in utilization management or managed care
  • Strong knowledge of medical terminology and clinical workflows
  • Experience applying medical necessity criteria such as InterQual
  • Excellent communication, documentation, and organizational skills
  • Ability to multitask, prioritize workload, and meet deadlines

Preferred:

  • Previous Utilization Management or Prior Authorization experience
  • Experience with EPIC and/or IQ Cloud systems
  • Knowledge of Medicare Advantage and Commercial plan requirements
  • Strong understanding of compliance, audits, and regulatory processes
  • Ability to work independently in a remote environment

Additional Information:

  • License Required: Yes – Active LVN/LPN (Compact State or Texas)
  • Dress Code: Business casual (remote-appropriate)
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