Remote Prior Authorization Nurse Associate - LPN/LVN - USA - Transforming Healthcare through Compassionate Care
Bringing Our Heart to Every Moment of Your Health At CVS Health, we're on a mission to revolutionize the healthcare landscape by making it more personal, convenient, and affordable. Our purpose is built on a foundation of compassion, empathy, and a deep commitment to delivering exceptional care. As a Remote Prior Authorization Nurse Associate - LPN/LVN, you'll play a vital role in our efforts to transform the healthcare experience for our members.
About Our Company
Culture Our Heart At Work Behaviors guide our actions and decisions, ensuring that we're always putting our members first. We're a company that values diversity, inclusivity, and teamwork, and we're dedicated to creating a work environment that's supportive, engaging, and rewarding. As a CVS Health team member, you'll be empowered to make a real difference in the lives of our members, and you'll have access to a range of tools, resources, and opportunities to help you grow and succeed. Job Summary We're seeking a highly skilled and compassionate LPN/LVN to join our team as a Remote Prior Authorization Nurse Associate. In this 100% remote role, you'll work closely with our Commercial PA team to process and communicate prior authorizations for pharmacy benefits. You'll be the primary point of contact for physician office staff, customer service, admissions, and pharmacy operations departments, and you'll play a critical role in ensuring that our members receive the care they need in a timely and efficient manner.
Key Responsibilities
Review criteria-based prior authorizations following policy and procedure, and communicate referral status to relevant stakeholders. Provide on-call after-hours nurse availability for urgent PA requests, ensuring that our members receive the care they need, even outside of regular business hours. Collaborate with pharmacists, other clinical colleagues, healthcare professionals, and members to resolve prior authorization requests and address any questions or concerns. Train and mentor representatives on the PA team, sharing your expertise and helping to drive team success. Maintain accurate and complete documentation of all necessary information, utilizing computer system data entry, data management, and reporting tools. Answer inbound phone calls, process cases, load authorizations, and make follow-up phone calls as needed, demonstrating excellent verbal and written communication skills. Shift priorities while exhibiting a high level of urgency with all calls and assignments, adapting to a fast-paced and changing environment. Utilize clinical skills to support the documentation and communication of medical services and prior authorization determinations.
Essential Qualifications
Minimum 2 years of clinical experience as a LPN/LVN, with a strong track record of delivering high-quality patient care. Unrestricted LPN/LVN license in your state of residence, with a commitment to staying up-to-date on the latest clinical guidelines and best practices. Willingness and ability to work an 8-hour shift, Monday through Friday, between 8am and 8pm in your time zone, with occasional weekend work as needed. Excellent communication skills, both written and verbal, with the ability to effectively interact with a range of stakeholders. Proficiency with computer skills, including navigating multiple systems and keyboarding, with a strong ability to adapt to new technologies. Preferred Qualifications 3+ years of prior related clinical work experience, with a strong background in prior authorization, case management, or a related field. Experience using MS Office and other Windows-based computer applications, with a high level of proficiency in digital charting and other relevant tools. Previous experience in a managed care or health plan setting, with a deep understanding of the complexities of healthcare delivery. Call center experience, with a strong ability to multitask, prioritize, and effectively manage a high volume of calls. Prior remote experience, with a proven track record of success in a virtual work environment. Education LVN/LPN Diploma or Associate's degree in nursing as LPN/LVN.
What We Offer
At CVS Health, we're committed to supporting the well-being and success of our team members. In addition to a competitive compensation package, which includes a base hourly rate of $21.10 - $53.53, depending on experience and location, we offer a range of benefits and perks, including: A comprehensive benefits package, including medical, dental, and vision coverage. A 401(k) retirement savings plan, with a generous company match. An Employee Stock Purchase Plan, allowing you to purchase CVS Health stock at a discounted rate. Term life insurance, short-term and long-term disability benefits, and other financial protection programs. Numerous well-being programs, education assistance, and free development courses to support your personal and professional growth. A CVS store discount, and discount programs with participating partners. Pai Apply tot his job Apply To this Job