Job Summary
At CVS Health, we're on a mission to build a world of health around every consumer, driven by a team of dedicated colleagues who are passionate about transforming healthcare. As the nation's leading health solutions company, we touch the lives of millions of Americans through our local presence, digital channels, and over 300,000 purpose-driven colleagues. We're looking for a skilled and compassionate Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) to join our team as a Prior Authorization Specialist. This is a full-time remote position that offers the opportunity to work with a dynamic team, make a meaningful impact, and enjoy a flexible work environment.
About CVS Health
CVS Health is a healthcare company that goes beyond traditional healthcare services. We're committed to making healthcare more accessible, convenient, and compassionate. Our company culture is built on the principles of heart, innovation, and community. We believe that our colleagues are our greatest asset, and we're dedicated to fostering a workplace where everyone feels valued, respected, and empowered to make a difference.
Our Mission
Our mission is to improve the health and well-being of our customers, patients, and members. We're passionate about delivering high-quality healthcare services that are tailored to the unique needs of each individual. Our goal is to make healthcare more accessible, affordable, and effective, and we're committed to making a positive impact on the communities we serve.
Key Responsibilities
As a Licensed Practical Nurse - Prior Authorization Specialist, you will play a critical role in our Pharmacy Operations team. Your primary responsibilities will include:
- Reviewing and processing prior authorizations for pharmacy benefits, ensuring compliance with program criteria and policies.
- Communicating with physician office staff, customer service teams, admissions, and pharmacy operations departments to provide updates on referral status.
- Overseeing fax processing and providing telephone call assistance to prescriber office staff, pharmacies, and members.
- Loading authorizations, making follow-up phone calls, and maintaining accurate documentation of all necessary information.
- Utilizing clinical skills to support the documentation and communication of medical services and prior authorization determinations.
- Providing on-call after-hours nurse availability for urgent prior authorization requests.
- Offering internal nurse support to the Prior Authorization team and member services department.
- Referring cases that do not meet clinical criteria to the Pharmacist and MD teams.
- Training and mentoring representatives on the Prior Authorization team.
Requirements and Qualifications
Essential Qualifications
To be successful in this role, you will need:
- A minimum of 2 years of clinical experience as a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN).
- A minimum of 2 years of prior authorization experience.
- An unrestricted license to practice as an LPN or LVN in your state of residence.
- The ability to work a set schedule for initial training (8am-4:30pm CST, Monday-Friday) and a permanent schedule with varying shifts (Monday-Friday, 8am-8pm CST).
- Excellent verbal and written communication skills.
- Proficiency with computer skills, including navigating multiple systems and keyboarding.
- Regular and predictable attendance.
Preferred Qualifications
We prefer candidates with:
- 3+ years of prior related clinical work experience.
- Experience using MS Office and other Windows-based computer applications.
- Digital charting experience.
- Managed care or health plan experience.
- Call center experience.
- Multi-tasking experience.
- Prior remote work experience.
- Case management experience.
- High production experience.
What We Offer
Compensation and Benefits
We offer a competitive salary range of $21.10 - $48.67 per hour, depending on experience and qualifications. In addition to our base pay, you will be eligible for:
- A CVS Health bonus, commission, or short-term incentive program.
- A comprehensive benefits package, including affordable medical plan options, a 401(k) plan with matching company contributions, and an employee stock purchase plan.
- No-cost programs for all colleagues, including wellness screenings, tobacco cessation and weight management programs, confidential counseling, and financial coaching.
- Paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, and retiree medical access.
Career Growth and Learning Opportunities
At CVS Health, we're committed to helping our colleagues grow and develop their skills. As a Prior Authorization Specialist, you will have opportunities to:
- Develop your clinical and communication skills.
- Work with a dynamic team of healthcare professionals.
- Contribute to the development of new processes and procedures.
- Participate in training and mentoring programs.
Work Environment and Culture
Our company culture is built on the principles of heart, innovation, and community. We believe that our colleagues are our greatest asset, and we're dedicated to fostering a workplace where everyone feels valued, respected, and empowered to make a difference. As a remote worker, you will have the flexibility to work from home and enjoy a better work-life balance.
How to Apply
If you're a compassionate and detail-oriented LPN or LVN looking for a new challenge, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, to be considered for this role.
Don't miss this chance to join our team and make a meaningful impact on the lives of our customers, patients, and members. Apply today and take the first step towards a rewarding career with CVS Health!
Apply Now