Nurse Associate

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🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $22 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

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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 complex clinical criteria-based prior authorizations electronically and/or in writing according to CVS/Caremark policies, procedures, and health plan/employer criteria • Refer cases that do not meet clinical criteria for upper-level review when appropriate • Manage calls, prior authorization requests, and ad hoc assignments with urgency and responsiveness • Follow prior authorization procedures and support business quality, regulatory, and accreditation standards • Participate in ongoing quality assurance activities, including reviewing work instructions and job aids • Collaborate with prior authorization representatives, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members • Complete additional prior authorization assignments delegated by leadership • Research documentation, communicate medical services, and make prior authorization determinations using clinical and problem-solving skills • Multitask and adapt effectively in a fast-paced changing environment • Work sedentary shifts involving telephone communication, multiple computer programs and screens, and keyboarding • Maintain regular and predictable attendance • Work required overtime and weekends when business needs require

🎯 Requirements

• Hold and maintain an active, unencumbered LPN/LVN license in the state of practice • Graduate of a State Agency-approved and/or NLNAC-accredited school of Practical Nursing • Hold a full, active, and unrestricted Licensed Practical Nurse license in a US state, territory, commonwealth, or the District of Columbia • Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria in a specialty/skilled clinical setting, such as a specialty medical office or Pharmacy Benefits Manager • Proficiency with computer skills, including multitasking, navigating multiple systems, and keyboarding • Experience using MS Office, Windows-based computer applications, web-based processing, and telephony programs • Excellent written and verbal communication skills • Ability to multitask, prioritize, and adapt to a fast-paced changing environment • Regular and predictable attendance • Ability to work business-required overtime and weekends when required

🏖️ Benefits

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