RPh Operations Advisor – Medical Prior Authorizations
Description: • 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 to complete prior authorization reviews • Take inbound calls from physicians or members regarding pending, approved, or denied prior authorizations • Issue clinical determinations within Aetna Medical PA and Novologix • Follow all prior authorization procedures to ensure timely and accurate processing of each prior authorization • Train and mentor representatives on the PA team • Collaborate with clinical colleagues and healthcare professionals to resolve cases • Prioritize work with a high level of urgency on calls and assignments 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 • Ability to work operational hours 8am-7pm CT (able to work 8am-7pm CT) • Willingness to work rotating weekends and occasional holidays per business needs • Excellent interpersonal skills • 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 • 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 • 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 • Bachelor of Pharmacy or PharmD Benefits: • competitive benefit package including vacation • employee discounted stock purchase program • 401K / 401(k) plan (including matching company contributions) • tuition reimbursement / tuition assistance • 20-30% employee discount at all CVS stores • Affordable medical plan options • No-cost programs including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Retiree medical access • Employee stock purchase plan Apply tot his job