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