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 for this job