LPN – Case Review – Work from Home job vacancy in CVS Health – Jobs in Virginia

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Job Details
Company Name : CVS Health
Company Location : Virginia
Job Position : LPN – Case Review – Work from Home
Job Category : Jobs in Virginia

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 procedure
  • Provide on-call after hours nurse availability for urgent PA requests
  • 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.
  • 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.

Pay Range

The typical pay range for this role is:

Minimum: 21.88

Maximum: 47.12

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

  • Active LPN license in the state of practice.
  • Minimum one year experience
  • Experience using MS Office and other Windows-based computer applications and phone use.
  • Six months experience processing Novologix medical prior authorizations.

Preferred Qualifications

Excellent interpersonal skills, demonstrate problems 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, required to possess a high mental agility and alertness. Ability to effectively communicate with pharmacists, other clinical colleagues, healthcare professionals and members; Ability to effectively prioritize work while exhibiting a high level of urgency with all calls and assignments; Follows all prior authorization procedures to ensure a timely and accurate process on each prior authorization; Ability to effectively train and mentor representatives on the PA team; Execute other PA assignments as delegated by the PA supervisor or manager.


Required: Active LPN license in the state of practice.

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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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