LPN – Utilization Management

Job not on LinkedIn

🔥 17 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $22 - $48 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Review criteria-based prior authorizations according to policy and procedure • Provide on-call after-hours nurse availability for urgent prior authorization requests • Provide internal nurse support to the PA team and member services department • Refer cases not meeting clinical criteria to Pharmacist and MD teams • Communicate prior authorization status with physician office staff and customer service, admissions and pharmacy operations departments • Process fax requests and provide telephone assistance to prescriber office staff, pharmacies and members • Answer inbound phone calls • Process cases and load authorizations • Make follow-up phone calls • Maintain complete and accurate documentation through computer system data entry, data management and reporting • Work with pharmacists, clinical colleagues, healthcare professionals and members • Train and mentor representatives on the PA team • Complete other prior authorization assignments delegated by PA leadership

🎯 Requirements

• Prior work experience working prior authorizations in Novologix • Excellent interpersonal skills • Demonstrated problem-solving ability and attention to detail • Ability to work effectively in a team environment with great dependability • Excellent oral and written communication skills • Ability to quickly assess and adapt to constantly changing situations • Phone and PC use • High mental agility and alertness • Ability to effectively communicate with pharmacists, clinical colleagues, healthcare professionals and members • Ability to effectively prioritize work with a high level of urgency • Ability to follow prior authorization procedures accurately and timely • Ability to train and mentor representatives on the PA team • Active LPN license in the state of practice required • Associate’s or Bachelor’s Degree in Nursing preferred • Ability to work 40 hours per week

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay