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.
Position Summary
This position is 100% remote
Working hours will be Tuesday-Friday 9:30AM – 6:00PM EST, Saturday 8:00AM - 4:30PM EST. Holidays will be on rotation.
No travel is required.
Applicants from any state can apply.
Job Description
Utilizes clinical and critical thinking skills to complete notice of action (NOA) letters members and providers for approved or denied services. Requires LPN/LVN with unrestricted active license.
Promotes/supports quality effectiveness of Healthcare Services and benefit utilization Utilizes clinical and critical thinking skills to write and audit notice of action letters to members and providers for approved or denied services. Collects information to support the process of rendering appropriate, member friendly, notice of action letters. Utilizes clinical experience, criteria/guidelines, policies, and procedures in support of ensuring that letters are timely and accurate. We work closely with the utilization management team.
Required Qualifications
- 1 year of clinical experience required
- LPN/LVN with current unrestricted licensure required
Preferred Qualifications
- 2 years managed care experience.
- 2 years prior authorization experience.
- Prior experience using Quadient and/or MedCompass.
- Effective communication and organization skills.
- Outpatient Clinical experience
- Knowledge of Medicare/Medicaid
- Computer literacy to navigate through Internal/external computer systems, including Excel and Microsoft Word.
Education
Licensed Practical/ Vocational Nurse diploma/ Associate Degree
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$21.10 - $43.78This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 03/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.