Job Description
Job Summary
CVS Health is seeking dedicated and detail-oriented Healthcare Prior Authorization Specialists to join our remote team. In this role, you will play a critical part in ensuring patients receive timely access to necessary healthcare services while complying with regulatory standards and internal policies. This position requires strong analytical skills, effective communication, and a commitment to patient care.
As a remote team member, you will collaborate with healthcare providers, insurance teams, and internal stakeholders to facilitate prior authorization requests for medications, procedures, and therapies. Your contributions will directly impact patient outcomes and improve the overall efficiency of the healthcare system.
Key Responsibilities
- Review, evaluate, and process prior authorization requests submitted by healthcare providers for medications, medical procedures, and therapies.
- Ensure requests meet clinical criteria, coverage policies, and regulatory compliance requirements.
- Collaborate with physicians, pharmacists, and other healthcare professionals to gather necessary documentation and clinical information.
- Communicate authorization decisions effectively to providers and internal teams.
- Maintain accurate records of all prior authorization activities and patient interactions in internal systems.
- Identify and escalate complex cases or issues requiring clinical or managerial review.
- Stay current on industry regulations, CVS Health policies, and insurance guidelines.
Required Skills and Qualifications
- Strong understanding of healthcare terminology, medical procedures, and insurance processes.
- Excellent written and verbal communication skills.
- Ability to analyze clinical information and make accurate decisions based on policy guidelines.
- Proficient in using electronic medical records (EMR) systems and other healthcare software tools.
- Strong organizational skills and attention to detail.
- Ability to manage multiple tasks and meet deadlines in a remote work environment.
Experience
- Minimum 1–2 years of experience in prior authorizations, medical billing, nursing, pharmacy, or related healthcare fields preferred.
- Experience in a remote or virtual healthcare setting is an advantage.
Working Hours
- Full-time, remote position with flexible scheduling options.
- Must be able to work during core business hours; some evening or weekend shifts may be required based on business needs.
Knowledge, Skills, and Abilities
- Strong clinical knowledge relevant to the healthcare services being authorized.
- Ability to interpret complex medical records and insurance guidelines.
- Excellent critical thinking, problem-solving, and decision-making skills.
- Customer-focused mindset with the ability to handle sensitive patient information confidentially.
- Adaptability to changing processes, guidelines, and technology platforms.
Benefits
- Competitive salary with performance incentives.
- Comprehensive healthcare coverage, including medical, dental, and vision.
- Paid time off, holidays, and wellness programs.
- 401(k) retirement plan with company match.
- Opportunities for professional development and career advancement.
- Remote work flexibility and supportive team environment.
Why Join CVS Health
CVS Health is a leading healthcare innovation company dedicated to helping people on their path to better health. As part of our remote Prior Authorization team, you will make a meaningful impact on patient care, while enjoying the flexibility and support of a top-tier employer. Join us to advance your career in healthcare while contributing to an organization committed to making healthcare more accessible and efficient.
How to Apply
Interested candidates can apply online via the CVS Health Careers portal. Ensure your resume highlights relevant prior authorization, clinical, or healthcare experience, and include a concise cover letter demonstrating your motivation for joining our remote healthcare team.
Job Details
| Salary |
$10 - $20 |
| Job Type |
Full-time |
| Remote/Onsite |
Remote |
| Location |
|
| Last Apply Date |
2026-03-22 |