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Company Name : CVS Health
Location : Texas
Position : LPN – Case Review – Work from Home
Job Description : This position is a 100% remote, work from home opportunity and will not be patient facing.
You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Caremark Specialty Medical Prior Authorization department. Reporting to the Pharmacy Operations Manager, you will work with physician office staff and customer service, admissions and pharmacy operations departments to communicate prior authorization status. You will also oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and making follow-up phone calls. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.
Review criteria-based prior authorizations following policy and procedureProvide on-call after hours nurse availability for urgent PA requestsProvide 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.Excellent verbal and written skills.You will work with pharmacists, other clinical colleagues, healthcare professionals and members.Follow all prior authorization procedures to guarantee an accurate process on each prior authorization.Train and mentor representatives on the PA team. Complete other PA assignments as delegated by the PA leadership team.
There is the potential for evening and weekends in this direct hire, benefited role. Offering excellent Medical, Dental and Vision coverage, a 401k, and additional benefits.
Required Qualifications
Active LPN license in the state of practice.Minimum one year experienceExperience using MS Office and other Windows-based computer applications and phone use.
COVID Requirements
CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications
3 to 5 years prior related work experienceAssociate’s or Bachelor’s Degree in Nursing
Education
High School Diploma or GED equivalent
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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