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Prior Authorization Nurse Associate LPN/LVN - Remote GA ID-9798

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.

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Position Summary

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

The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy 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

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 state of residence

- Must be willing and able to work 8 hour shift Monday through Friday, between 8am and 8pm in time zone of residence

- Must be willing and able to work occasional weekends per business needs

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

Education

LVN/LPN Diploma

Associate's degree in nursing as LPN/LVN

Prior Authorization Nurse Associate LPN/LVN - Remote GA ID-9798

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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