LPN - Utilization Management

CVS Health•Work At Home-Texas, TX

2d•$22 - $49•Onsite

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary 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.

Requirements

Prior work experience working prior authorizations in Novologix.
Excellent interpersonal skills
Demonstrated 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.
Active LPN license in the state of practice required

Nice To Haves

0 to 3 years prior work experience
Associate's or Bachelor's Degree in Nursing

Responsibilities

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.
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.