LPN – Utilization Management
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Job Description
LPN managing specialty medication prior authorizations for CVS Health’s Caremark operations. Reviewing cases, communicating status, and supporting pharmacists, providers, pharmacies, and members.
Responsibilities:
- Review criteria-based prior authorizations according to policy and procedure
- Provide on-call after-hours nurse availability for urgent prior authorization requests
- Provide internal nurse support to the PA team and member services department
- Refer cases not meeting clinical criteria to Pharmacist and MD teams
- Communicate prior authorization status with physician office staff and customer service, admissions and pharmacy operations departments
- Process fax requests and provide telephone assistance to prescriber office staff, pharmacies and members
- Answer inbound phone calls
- Process cases and load authorizations
- Make follow-up phone calls
- Maintain complete and accurate documentation through computer system data entry, data management and reporting
- Work with pharmacists, clinical colleagues, healthcare professionals and members
- Train and mentor representatives on the PA team
- Complete other prior authorization assignments delegated by PA leadership
Requirements:
- Prior work experience working prior authorizations in Novologix
- Excellent interpersonal skills
- Demonstrated problem-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
- High mental agility and alertness
- Ability to effectively communicate with pharmacists, clinical colleagues, healthcare professionals and members
- Ability to effectively prioritize work with a high level of urgency
- Ability to follow prior authorization procedures accurately and timely
- Ability to train and mentor representatives on the PA team
- Active LPN license in the state of practice required
- Associate’s or Bachelor’s Degree in Nursing preferred
- Ability to work 40 hours per week
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program in addition to base pay
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