Prior Authorization Nurse Associate, LPN/LVN

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🔥 6 minutes ago

🏈 Alabama, Arizona, +2 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🐊 Florida – Remote 🤠 Texas – Remote

💵 $21 - $53 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

✨ Associate

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits • Review criteria-based prior authorizations following policy and procedure • Provide internal nurse support to the PA team and member services department • Refer cases not meeting clinical criteria to the Pharmacist and MD team(s) • Shift priorities while exhibiting a high level of urgency with all calls and assignments • Follow all prior authorization procedures to guarantee an accurate process on each prior authorization • Complete other PA assignments as delegated by the PA leadership team • Perform and handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve calls with a one call solution • Perform other related projects and duties as assigned, including attending training sessions and development meetings

🎯 Requirements

• Minimum 2 years clinical experience as an LPN/LVN • A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence or a compact license • Prior authorization experience or Case Management experience • 3+ years prior related clinical work experience • Ability to prioritize, quickly assess, manage multiple tasks, and adapt to constantly changing situations • Experience using MS Office and other Windows-based computer applications and phone use • Digital charting • Managed care or health plan previous experience • Call center experience • Multi-tasking experience • Prior remote experience preferred • Case Management experience preferred • Prior authorization experience • High production experience • Excellent organizational skills • Strong detail orientation

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs and other resources