R0537990
Description
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary
This is a full-time remote position for candidates who have Prior Authorization experience.
Schedule: There is a set schedule for initial training from 8am-4:30pm CST Monday-Friday.
Following training, colleagues will have a permanent schedule, but the shift range will vary and is subject to change. Monday thru Friday ranging from 8 am to 8 pm cst.
The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits. Reporting to the Pharmacy Operations Manager, working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status. You will also oversee fax processing and providing telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Responsibilities include processing cases, loading authorizations, and making follow-up phone calls. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.
– Review criteria-based prior authorizations following policy and procedure
– Provide on-call after hours nurse availability for urgent PA requests
– Provide internal nurse support to the PA team and member services department Refer cases not meeting clinical criteria to the Pharmacist and MD team(s).
– Shift priorities while exhibiting a high level of urgency with all calls and assignments.
– Excellent verbal and written skills.
– You will work with pharmacists, other clinical colleagues, healthcare professionals and members.
– Follow all prior authorization procedures to guarantee an accurate process on each prior authorization.
– Train and mentor representatives on the PA team. Complete other PA assignments as delegated by the PA leadership team.
– Utilization of clinical skills to support the documentation and 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 periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
– Position requires proficiency with computer skills which include navigating multiple systems and keyboarding
– Excellent communication skills, both written and verbal
– Must have regular and predictable attendance
Required Qualifications
– Minimum 2 years clinical experience as a LPN/LVN.
– Minimum 2 years Prior Authorization (PA) experience
– A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in state of residence
– Must be willing and able to work 8 hour shift Monday through Friday, between 8am and 8pm cst with the possibility of weekend rotation.
– Must be willing and able to work occasional weekends per business needs
Preferred Qualifications
– 3+ years prior related clinical work experience
– Experience using MS Office and other Windows-based computer applications and phone use.
– Digital charting
– Managed care or health plan previous experience,
– Call center experience
– Multi-tasking experience
– Prior remote experience
– Case Management experience
– Prior authorization experience
– High production experience
Education
LVN/LPN Diploma
Associate’s degree in nursing as LPN/LVN
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$21.10 – $48.67
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 04/30/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.