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 ourselvesaccountable 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

- Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests.
- Promotes and supports quality effectiveness of healthcare and Pharmacy Services.
- Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines.
- Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria.
- Determines appropriateness for medications. Communicates decision to physicians, physician's office staff, medical management staff, members, and/or pharmacists.
- Will perform clinical research to support request.
- Performs non-medical research including eligibility verification, COB, and benefits verification.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Process requests in compliance with various laws and CMS regulations and company policies and procedures.
- May communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers.
- Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services.
- Sedentary work involving significant periods of sitting, talking, hearing, and keying.
- Escalates requests to Pharmacist when request requires extensive clinical review or denial.

Required Qualifications

- National Pharmacy Technician certification and Home State License, current and in good standing, are required.
- Proficiency in computerized pharmacy systems and software applications.
- Excellent verbal and written communication skills.
- Experience with Windows-based software applications.
- Utilizes various proprietary systems to build, research, process and enter requests.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Preferred Qualifications

- High volume call center and production unit.
- Experience in retail, hospital, facility or call center is preferred.

Education

High School diploma, G.E.D.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.