RPh Operations Advisor - Aetna Medical Prior Authorizations

CVS Health•Washington, DC

3d•$45 - $93•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 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, and we are seeking a candidate who is able to work 8am-7pm CT. Rotating weekends and occasional holidays may be required per business needs. The position is fully remote.

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

Nice To Haves

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

Responsibilities

Conducts reviews of medical data collected to perform prior authorization review for specialty medications.
Apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.
Work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.