RPh Operations Advisor - Aetna Medical Prior Authorizations
Description:
• Clinical Pharmacist with the Specialty Medical Prior Authorization team conducts reviews of medical data collected to perform prior authorization review for specialty medications.
• Applies 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 9am-6pm CT. Rotating weekends and occasional holidays may be required per business needs. The position is fully remote.
• We offer a competitive benefit package including vacation, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at all CVS stores.
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
• 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
• 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.
Benefits:
• Competitive benefits package including vacation, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at CVS stores.
• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions addressing paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and many other benefits depending on eligibility.
• For more information, visit https://jobs.cvshealth.com/us/en/benefits
Apply Now
Apply Now
• Clinical Pharmacist with the Specialty Medical Prior Authorization team conducts reviews of medical data collected to perform prior authorization review for specialty medications.
• Applies 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 9am-6pm CT. Rotating weekends and occasional holidays may be required per business needs. The position is fully remote.
• We offer a competitive benefit package including vacation, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at all CVS stores.
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
• 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
• 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.
Benefits:
• Competitive benefits package including vacation, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at CVS stores.
• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions addressing paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and many other benefits depending on eligibility.
• For more information, visit https://jobs.cvshealth.com/us/en/benefits
Apply Now
Apply Now