RPh Operations Advisor – Med D

Job not on LinkedIn

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $50 - $84 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Directly support Medicare Part D members and providers with requests related to pharmacy benefits • Accurately set up cases for members • Review clinical information to make decisions on requests • Perform outreach to providers for additional information when needed • Ensure accurate decisions comply with compendia and Medicare guidance and timelines • Review information and complete timely, accurate documentation of Medicare Part D requests in compliance with Medicare guidelines • Promote a best-in-class service experience

🎯 Requirements

• Active pharmacist license in the state of residence that is in good standing • Current experience as clinical Pharmacist reviewing Med D requests within Caremark PBM environment • Ability to utilize multiple software systems simultaneously with a 2-screen workstation setup, including Windows based operations, AS400, MHK, PeopleSafe, WI database, and Microsoft office applications • Ability to type 30 WPM or greater • Excellent oral and written communication skills • Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment • Ability to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome • Ability to work independently and utilize critical thinking/problem solving skills to make case decisions • Receptive to constructive feedback and flexible in adapting to change • Flexibility with working a rotating schedule including overtime, weekends, and holidays • Dedicated, quiet, uninterrupted home workspace that is secure from unintentional access and not accessible to common traffic • Stable personal high-speed internet with ability to hard-wire into company computer; wireless internet cannot be used • BS in Pharmacy or PharmD • 3+ years experience in Managed Care/PBM environment (preferred)

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility