Prior Authorization Representative - Work From Home

Job Opportunity At Cvs Health

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

The Prior Authorization colleague takes in-bound calls from providers, pharmacies, members, etc. providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. You will maintain complete, timely, and accurate documentation of reviews. As a Prior Authorization Representative you will make the determination if a complex request should be transferred to a pharmacist for assistance. You will also assist with other duties as needed to include but not limited to : outbound calls, reviewing and processing Prior Authorizations received via fax & ePA, and other duties as assigned by the leadership team.

Must have open availability from 8 : 00am - 8 : 00pm CST. Nationwide work from home.

Primary Duties And Responsibilities

• Effectively manage work volume by handling inbound calls / fax / ePA requests utilizing appropriate courteous and professional behavior.
• Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy.
• Communication with other internal groups regarding determination status and results.
• Identify and elevate clinical inquiries to the pharmacist team as appropriate.
• Other duties assigned, for example faxes, sorting, ePA, etc.

Required Skills & Other Minimum Required Qualifications

Required Qualifications

Physical Requirements

Work Environment (Home Office)

Education

Verifiable High School Diploma or GED required.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is : $17.00 - $34.15

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.

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.

We anticipate the application window for this opening will close on : 12 / 05 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. 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.