Job Description
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) referrals reviewed by the Case Review Unit for the Specialty Guideline Management Programs for the Pharmacy and Medical benefits. Reporting to the Pharmacy Operations Manager, working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status. You will also oversee fax processing and providing 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.
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.
Preferred Qualifications
* 3 to 5 years prior related work experience
* Associate'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.
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) referrals reviewed by the Case Review Unit for the Specialty Guideline Management Programs for the Pharmacy and Medical benefits. Reporting to the Pharmacy Operations Manager, working with physician office staff and customer service, admissions and pharmacy operations departments to communicate referral status. You will also oversee fax processing and providing 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.
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.
Preferred Qualifications
* 3 to 5 years prior related work experience
* Associate'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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