RPh Operations Advisor - Med D

CVS Health

1d • $50 - $85 • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting 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
• Demonstrated ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, 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
• Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome
• Must be able 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 home workspace needed. Must be able to provide a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional access.
• Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet).

Nice To Haves

• 3+ years experience in Managed Care/PBM environment
• BS in Pharmacy or PharmD

Responsibilities

• Directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits.
• Ensuring cases are accurately set up for our members
• Review clinical information for decisioning the request
• Performing outreach to providers for more information when needed
• Ensuring accurate decisions that comply with compendia and Medicare guidance and timelines.
• Completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees