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.