Licensed Vocational Nurse/Licensed Practical Nurse--Remote

Description

CVS MAX Bill Rate: $38.48

• Please include screenshot of speed test at top of resume.
  
  

For this assignment the team PREFERS to have CWs located in the MST or PST time zone; shifts typically end around 8 or 9pm EST so CWs in those time zones usually work out better.

Role Timeline

Offer 3/3/25

Offer Acceptance 3/7/25

Last day to clear 3/21/25

Start 3/31/25

Safety sensitive

This is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA compliant work area away from distractions, and must have their own secure private internet services of at least 25mbps download/3mbps upload in order to ensure sufficient speed to adequately perform work duties. Must provide a screenshot of internet speeds with resume and provide license number.

• Training schedule is approximately six weeks starting 3/31/2025, Monday to Friday 8:00am - 4:30pm CST, then schedule will be assigned: Expected shifts to be 8 hours per day, which will include one weekend day per week. Candidates in MT and PT time zones are preferred.
  
  

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.

Responsibilities include answering inbound phone calls, processing cases and electronic authorizations, loading authorizations, and making follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards. 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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Additional Details

• ALERT: : This employer requires all employees, temporary labor, consultants, and contractors to be fully vaccinated against COVID-19 by their start date (other date may be inserted if start date is not accurate), subject to approved medical or religious exemptions.
• Is this request for Peak Season? Select applicable value : RAMP - Clinical Commercial Attrition
• Duties : Responsibilities include answering inbound phone calls, processing cases and electronic authorizations, loading authorizations, and making follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards. 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.
• Experience :
• Must have active, current and unrestricted Licensed Practical/Vocational Nurse in state of residence
• 2 years of LPN/LVN clinical experience
• 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
• Position Summary : 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. 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.
• Education : The Licensed Practical Nurse is a graduate of a school of Practical or Vocational Nursing, approved by the State Agency and/or accredited by the National League for Nursing (Accrediting Commission (NLNAC)) at the time the program was completed by the applicant. The LPN/LVN must have a full, active and unrestricted license as a Licensed Practical or Vocational Nurse in a State, Territory or Commonwealth of the United States or District of Columbia. Registered Nures - RN license is acceptable as well.
• What days & hours will the person work in this position? List training hours, if different. : Monday to Friday 8:00am - 4:30pm CST for training: Expected shifts to be 8 hours per day
• Type of Start : Class with set start date
• Program Office - Point Of Contact : Deanna Morris
• Is this an in-person, patient-facing role? : No
• Onsite Requirements : Fully remote (never coming onsite)
  
  

Qualification Assessment Must Have CVS Caremark Requirements

Prior CVS/Aetna work experience?

No

Verifyable High School Diploma or GED Required

Yes