Remote Prior Authorization LPN/LVN Opportunity

Join our innovative and supportive team as a Remote Prior Authorization LPN/LVN, where you'll play a vital role in delivering exceptional patient care and making a meaningful impact in the healthcare industry. We offer a flexible, hybrid remote work arrangement, a competitive salary package, and a collaborative environment that fosters growth and development. As a key member of our team, you will utilize your clinical expertise to drive success and make a difference in the lives of our patients.

At CVS Health, our purpose is to bring heart to every moment of our patients' healthcare journeys. We are committed to delivering enhanced, human-centric healthcare solutions that are personal, convenient, and affordable. Our Heart At Work Behaviors guide our actions and decisions, empowering us to transform our culture and accelerate innovation. If you share our passion for healthcare and are dedicated to making a positive impact, we encourage you to apply for this exciting opportunity.

Job Summary

We are seeking a highly skilled and experienced LPN/LVN to join our Prior Authorization team. As a Prior Authorization LPN/LVN, you will be responsible for collecting and analyzing clinical data, conducting reviews, and making determinations based on health plan criteria. You will also coordinate communication with physicians, patients, and other healthcare professionals, ensuring timely and effective decision-making. Your expertise and attention to detail will be essential in driving quality outcomes and enhancing patient care.

Key Responsibilities

• Collect and analyze clinical data to perform reviews and make determinations based on health plan criteria
• Conduct prospective, concurrent, and retrospective reviews of cases
• Document clinical data and decisions in electronic and written formats
• Coordinate communication with physicians, patients, and other healthcare professionals
• Generate and review reports related to program results
• Participate in implementation of new Specialty Pharmacy Programs
• Document and validate client-specific processes and procedures

Requirements

• Active, unencumbered LPN/LVN license in the state of practice
• Minimum 2 years of recent experience reviewing and processing prior authorizations in a specialty/skilled clinical setting
• Proficiency in computer skills, including multitasking, navigating multiple systems, and keyboarding
• Experience using MS Office, other Windows-based computer applications, web-based processing, and telephony programs

Preferred Qualifications

• 3+ years of experience as an LPN/LVN in a specialty medical office or skilled clinical setting
• Graduate of a school of Practical Nursing approved by the State Agency and/or accredited by the National League for Nursing (Accrediting Commission (NLNAC))

What We Offer

• Competitive salary range: $22.40 - $48.67 per hour
• Eligibility for CVS Health bonus, commission, or short-term incentive program
• Comprehensive benefits package, including medical, dental, and vision coverage
• 401(k) retirement savings plan and Employee Stock Purchase Plan
• Paid Time Off (PTO) or vacation pay, paid holidays, and sick time
• Opportunities for professional growth and development

How to Apply

If you are a motivated and experienced LPN/LVN looking for a new challenge, please submit your application today. We can't wait to hear from you!