RPh Operations Advisor – Medical Prior Authorizations

Job not on LinkedIn

🔥 19 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $50 - $84 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚙️ 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

• Conduct reviews of medical data to perform prior authorization reviews for specialty medications • Apply clinical knowledge and planned approved criteria to prospective and concurrent case reviews • Work within CVS Caremark supported systems • Take inbound calls from physicians or members regarding pending, approved, or denied prior authorizations • 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 PA team as needed

🎯 Requirements

• 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 • Bachelor of Pharmacy or PharmD • Ability to work 8am-7pm CT • Rotating weekends and occasional holidays may be required • Excellent interpersonal skills • 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 • High mental agility and alertness • Ability to communicate with pharmacists, clinical colleagues, healthcare professionals, and members • Ability to prioritize work with a high level of urgency • Ability to train and mentor representatives on the PA team • Strong Microsoft Office skills • Experience utilizing CAS, Novologix, Sales Force, RxClaim, and PeopleSafe • Call center, PBM, or clinical experience

🏖️ Benefits

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