[Hiring] RPh Operations Advisor @CVS Health

Role Description

Are you ready to take your clinical skills to the next level? Check out this outstanding opportunity for a Clinical Pharmacist with the Specialty Medical Prior Authorization team!

The Clinical Pharmacist is an operations based role that conducts reviews of medical data collected to perform prior authorization review for specialty medications. The Clinical Pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.

• Operational hours are 8am-7pm CT.
• Candidate must be able to work 8am-7pm CT.
• Rotating weekends and occasional holidays may be required per business needs.
• The position is fully remote.

Qualifications

• Active pharmacist license in state of residence in good standing.
• 2+ years clinical pharmacist experience.
• 1+ years demonstrated experience issuing clinical determinations within Prior Authorizations.
• Current experience working within the Novologix system, specifically Aetna Medical Prior Authorization Operations.
• Current experience issuing clinical determinations within Aetna Medical PA.

Requirements

• Excellent interpersonal skills.
• Demonstrate problem 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.
• 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.
• Call center, PBM, or clinical experience.
• Strong Microsoft Office skills.
• Experience utilizing CAS, Novologix, Sales Force, RxClaim, and PeopleSafe.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.