Remote LPN/LVN – Case Review CST

CVS Health

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Job ID: 2511360BR
Category: Call Center
Remote: Fully Remote

Job Description
This position is a 100% remote, work from home in the USA opportunity and will not be patient facing.

• Working Hours will be 9am-5:30pm CST
• Weekend shifts and PM shifts preferable (Saturday or Sunday)- latest shift end time 8pm CST.
• Colleague will be required to work business required overtime/extended work week when needed

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.
• Utilization of clinical skills to support the documentation and communication of medical services and prior authorization determinations
• Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment
• This position involves sedentary work with periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
• Position requires proficiency with computer skills which include navigating multiple systems and keyboarding
• Excellent communication skills, both written and verbal
• Must have regular and predictable attendance

Pay Range
The typical pay range for this role is:
Minimum: 21.75
Maximum: 47.25

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit

Required Qualifications
* Minimum 2 years clinical experience as a LPN/LVN.

* A LVN (Licensed Vocational Nurse) or LPN (Licensed Practical Nurse) that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states.

Preferred Qualifications
• 3+ years prior related clinical work experience
• Experience using MS Office and other Windows-based computer applications and phone use.
• Digital charting
• Managed care or health plan previous experience,
• Call center experience
• Multi-tasking experience
• Prior remote experience
• Case Management experience
• Prior authorization experience
• High production experience
• Leadership & training experience

LVN/LPN Diploma
Associate’s degree in nursing as LPN/LVN

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.