Remote Prior Authorization Nurse Associate LPN/LVN – Specialty Medication Management

Transforming Healthcare with CVS Health: Join Our Team as a Remote Prior Authorization Nurse Associate LPN/LVN At CVS Health, we're on a mission to bring our heart to every moment of your health. As a leading healthcare organization, we're committed to delivering enhanced human-centric health care that's more personal, convenient, and affordable. Our purpose is at the heart of everything we do, guiding our actions and decisions as we strive to make a positive impact on the lives of our customers and colleagues. We're seeking a dedicated and experienced Prior Authorization Nurse Associate LPN/LVN to join our team in a 100% remote, work-from-home role. As a key member of our Specialty Guideline Management Programs team, you'll play a critical role in processing and communicating prior authorization referrals for specialty medications, working closely with physician office staff, customer service, admissions, and pharmacy operations departments. Key Responsibilities:

• Review complex clinical criteria-based prior authorizations in accordance with CVS/Caremark policies and procedures.
• Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
• Communicate referral status to physician office staff, customer service, admissions, and pharmacy operations departments.
• Oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies, and members based on program criteria.
• Answer inbound phone calls, process cases, load authorizations, and make follow-up phone calls as needed.
• Maintain complete and accurate documentation of all necessary information, involving computer system data entry, data management, and reporting.
• Participate in quality assurance activities on an ongoing basis, including 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.

Essential Qualifications:

• 2 years of clinical experience as a LPN/LVN.
• 1+ year of prior authorization experience in an MDO or a clinical setting.
• Unrestricted LPN/LVN license in your state of residence.
• Willingness and ability to work an 8-hour shift, Sunday through Saturday, between 8am and 8pm in your time zone.
• Willingness and ability to work occasional weekends per business needs.

Preferred Qualifications:

• 3+ years of prior related clinical work experience.
• Experience using MS Office and other Windows-based computer applications and phone use.
• Digital charting experience.
• Managed care or health plan previous experience.
• Call center experience.
• Multi-tasking experience.
• Prior remote experience.
• Case Management experience.
• High production experience.

Education: LVN/LPN Diploma required. Associate's degree in nursing as LPN/LVN preferred. What We Offer: As a CVS Health colleague, you'll enjoy a comprehensive benefits package, including:

• Competitive salary ($21.10 - $43.78 per hour).
• CVS Health bonus, commission, or short-term incentive program.
• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan and Employee Stock Purchase Plan.
• Fully-paid term life insurance plan and short-term and long-term disability benefits.
• Numerous well-being programs, education assistance, and free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay, and paid holidays throughout the calendar year.

Career Growth

Opportunities: At CVS Health, we're committed to helping our colleagues grow and develop in their careers. As a Prior Authorization Nurse Associate LPN/LVN, you'll have opportunities to:

• Develop your clinical skills and knowledge in a fast-paced, dynamic environment.
• Collaborate with cross-functional teams to drive business outcomes and improve customer experiences.
• Take on new challenges and responsibilities as you grow in your role.
• Participate in training and development programs to enhance your skills and expertise.

Our Culture: At CVS Health, we're passionate about creating a culture that supports our colleagues and customers. Our Heart At Work Behaviors guide our actions and decisions, and we're committed to:

• Empowering our colleagues to make a positive impact on the lives of our customers.
• Fostering a culture of inclusion, diversity, and respect.
• Providing opportunities for growth and development.
• Recognizing and rewarding outstanding performance.

Join Our Team: If you're a motivated and experienced LPN/LVN looking for a new challenge, we encourage you to apply for this exciting opportunity. As a Remote Prior Authorization Nurse Associate LPN/LVN, you'll play a critical role in driving business outcomes and improving customer experiences. Apply now and take the first step towards a rewarding new role! We anticipate the application window for this opening will close on: 10/02/2024. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. Don't miss this opportunity to make a significant impact. Apply now and join our team! Apply This Job Apply tot his job Apply To this Job