LPN - Utilization Management

CVS Health; Town of Texas (WI); Hybrid; USD 31,000 - 67,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Bonus eligibility

Job summary

CVS Health is seeking a Clinical PA Coordinator to process specialty medication prior authorization requests and communicate PA status with physician offices, customer service, and pharmacy operations. You will handle fax processing, take calls, and document all data accurately.

You will collaborate with pharmacists and clinicians, provide after-hours nurse support, and mentor PA team members while prioritizing urgent cases and adhering to PA procedures.

Qualifications

• Experience with prior authorizations in Novologix required.
• Excellent interpersonal and written communication skills; detail oriented.
• Ability to work in a team and handle urgent PA requests with accuracy.

Responsibilities

• Review PA criteria per policy and procedure.
• Provide after-hours nurse support for urgent PA requests.
• Train and mentor PA team representatives.
• Coordinate with prescribers, offices, and pharmacies to communicate PA status.
• ESSENTIAL: maintain documentation and data entry for all cases.

Skills

Prior authorizations experience

Interpersonal skills

Problem solving

Communication skills

Team collaboration

Education

Nursing degree (Associate/Bachelor)

Active LPN license

Tools

Novologix

PC/computer skills

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Caremark 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.

Required Qualifications

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; Follows all prior authorization procedures to ensure a timely and accurate process on each prior authorization; Ability to effectively train and mentor representatives on the PA team; Execute other PA assignments as delegated by the PA supervisor or manager.

Preferred Qualifications

• 0 to 3 years prior work experience
• Associate's or Bachelor's Degree in Nursing

Education

Associate's or Bachelor's Degree: Nursing preferred

Active LPN license in the state of practice required

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$22.40 - $48.67

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.

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 09/14/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.