RPh Advisor - Medicare Part D
About the position
Responsibilities
• Ensure accuracy of case setup and clinical review of Medicare appeals cases
• Review internal notes or fax requests thoroughly for pertinent information
• Provide clear, concise, and accurate documentation for case reviews
• Contact providers for clinical information to decision cases when needed
• Utilize work instructions and Medicare guidelines for accurate case processing
• Comply with CMS mandated timelines and department productivity and quality standards
• Acquire and utilize clinical judgement and knowledge, drug compendia resources, and CMS Medicare guidance
• Participate in development discussions receiving feedback from direct supervisor.
Requirements
• Active pharmacist license in the state of residence that is in good standing
• Current experience working within Caremark PA Ops
• Current experience with Medicare Part D cases
• Demonstrated ability to utilize multiple software systems simultaneously with a 2-screen workstation setup
• Ability to type 30 WPM or greater
• Demonstrated ability to utilize compendia (Micromedex, Lexicomp, etc) to evaluate and support case decisions
• 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
• Demonstrated ability 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
Nice-to-haves
• PGY1 Residency
Benefits
• Full range of medical, dental, and vision benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance plan
• Short-term and long-term disability benefits
• Well-being programs
• Education assistance
• Free development courses
• CVS store discount
• Discount programs with participating partners
• Paid Time Off (PTO) or vacation pay
• Paid holidays throughout the calendar year
Apply Now
Apply Now
Responsibilities
• Ensure accuracy of case setup and clinical review of Medicare appeals cases
• Review internal notes or fax requests thoroughly for pertinent information
• Provide clear, concise, and accurate documentation for case reviews
• Contact providers for clinical information to decision cases when needed
• Utilize work instructions and Medicare guidelines for accurate case processing
• Comply with CMS mandated timelines and department productivity and quality standards
• Acquire and utilize clinical judgement and knowledge, drug compendia resources, and CMS Medicare guidance
• Participate in development discussions receiving feedback from direct supervisor.
Requirements
• Active pharmacist license in the state of residence that is in good standing
• Current experience working within Caremark PA Ops
• Current experience with Medicare Part D cases
• Demonstrated ability to utilize multiple software systems simultaneously with a 2-screen workstation setup
• Ability to type 30 WPM or greater
• Demonstrated ability to utilize compendia (Micromedex, Lexicomp, etc) to evaluate and support case decisions
• 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
• Demonstrated ability 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
Nice-to-haves
• PGY1 Residency
Benefits
• Full range of medical, dental, and vision benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance plan
• Short-term and long-term disability benefits
• Well-being programs
• Education assistance
• Free development courses
• CVS store discount
• Discount programs with participating partners
• Paid Time Off (PTO) or vacation pay
• Paid holidays throughout the calendar year
Apply Now
Apply Now