RPh Operations Advisor - Aetna Medical Prior Authorizations

CVS Health • Work At Home-Florida, FL

4d • $50 - $85 • Remote

About The Position

This role is an operations-based position for a Clinical Pharmacist on the Specialty Medical Prior Authorization team. The Clinical Pharmacist will conduct reviews of medical data to perform prior authorization reviews for specialty medications. The role involves applying clinical knowledge to approved criteria for prospective and concurrent reviews of cases. The Clinical Pharmacist will utilize CVS Caremark supported systems and handle inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.

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

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
• Call center, PBM, or clinical experience
• Strong Microsoft Office skills
• Experience utilizing CAS, Novologix, Sales Force, RxClaim, and PeopleSafe.

Responsibilities

• Conduct reviews of medical data 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.
• Take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.
• Follows all prior authorization procedures to ensure a timely and accurate process on each prior authorization.
• Effectively train and mentor representatives on the PA team.

Benefits

• medical
• dental
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility
• CVS Health bonus, commission or short-term incentive program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level