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
• Review complex clinical criteria-based prior authorizations (electronically and/or in written format) in accordance with CVS/Caremark policies and procedures and per the health plan/employer agreed criteria.
• Refer prior authorization cases not meeting clinical criteria for upper-level review when appropriate.
• Must possess excellent communication skills, both written and verbal.
• Shift priorities while exhibiting a high level of urgency and responsiveness with all calls, prior authorization requests, and ADHOC assignments.
• Follow all prior authorization procedures to meet business quality standards and ensuring the operational unit is complying with regulatory requirements and accreditation standards.
• Participates in quality assurance activities on ongoing basis, including but not limited to reviewing work instructions and job aids regularly.
• Collaborate with representatives on the prior authorization team, pharmacists, clinical colleagues, healthcare professionals, clients, leaders, and team members.
• Complete other prior authorization assignments as delegated by the leadership team.
• Utilization of clinical and problem-solving skills to support the research of documentation, 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 extended periods of sitting, talking on the telephone, using multiple programs on multiple computer screens, and keyboarding.
• Must have regular and predictable attendance.
• Colleague will be required to work business required overtime/work weekends when business requires.
Required Qualifications
- Hold and maintain an active, unencumbered LPN/LVN license in the state of practice.
- Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows-based computer applications, web based processing and telephony programs.
- Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM).
Preferred Qualifications
- 3+ years prior work experience as an LPN/LVN in a specialty medical office, skilled clinical setting and/or PBM.
Education
- The Licensed Practical Nurse is a graduate of a school of Practical 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 must have a full, active, and unrestricted license as a Licensed Practical in a State, Territory or Commonwealth of the United States or District of Columbia.
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: 08/10/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Additional Information
Company: CVS Health
Location: Arizona
Salary: $22.40 - $48.67 per hour
Job ID: R0995733
Specialties: Prior Authorization
Required Licenses: LPN/LVN
Experience Level: 1-3 years
