RPh Operations Advisor - Aetna Medical Prior Authorizations
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
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.
Required Qualifications
- 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
Preferred Qualifications
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.
Education
Bachelor of Pharmacy or PharmD
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$50.48 - $84.62This 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.
