CVS Health

Utilization Management - Specialty Medical Prior Authorization - LPN

Posted on

June 30, 2025

Job Type

Full-Time

Role Type

Utilization Review

License

LPN/LVN

State License

Texas

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Company Description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Description

Must have Prior Authorization experience Will work from home office Position Summary: You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Aetna 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.

Requirements

Required Qualifications: Must have active, current and unrestricted Licensed Practical/Vocational Nurse in state of residence 2+ years of LPN/LVN clinical experience with experience in Prior Authorization 1+ years of experience using Microsoft Teams, including Word, Excel and Outlook Must be willing and able to work Monday through Friday, Sunday through Thursday or Tuesday through Saturday between hours of 8am to 8pm CST zone Preferred Qualifications: 1+ years prior work experience 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 Ability to effectively train and mentor representatives on the PA team Education: Diploma or Certification from approved LPN/LVN program

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Responsibilities

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. Complete other PA assignments as delegated by the PA leadership team.

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