RPh Operations Advisor – Medical Prior Authorizations

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $50 - $84 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚙️ Operations

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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

• Conduct reviews of medical data to perform prior authorization review for specialty medications • Apply clinical knowledge and approved criteria to prospective and concurrent case reviews • Use CVS Caremark-supported systems to process prior authorizations • Take inbound calls from physicians or members regarding pending, approved, or denied prior authorizations • Work operational hours of 8am–7pm CT • Work rotating weekends and occasional holidays as required by business needs • Issue clinical determinations within Aetna Medical Prior Authorization Operations • Follow prior authorization procedures to ensure timely and accurate processing • Train and mentor representatives on the prior authorization team • Communicate with pharmacists, clinical colleagues, healthcare professionals, and members • Prioritize calls and assignments with a high level of urgency

🎯 Requirements

• Active pharmacist license in state of residence in good standing • 2+ years of clinical pharmacist experience • 1+ years of 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 Prior Authorization • Excellent interpersonal skills • Problem-solving ability and attention to detail • Ability to work effectively in a team environment with dependability • Excellent oral and written communication skills • Ability to quickly assess and adapt to changing situations • High mental agility and alertness • Ability to communicate effectively with pharmacists, clinical colleagues, healthcare professionals, and members • Ability to effectively prioritize work while exhibiting urgency with calls and assignments • Ability to 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 • Bachelor of Pharmacy or PharmD • Ability to work 8am–7pm CT • Ability to work rotating weekends and occasional holidays as required

🏖️ 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