[Remote] RPh Operations Advisor at CVS Health

United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Licensed Registered Pharmacist
2 years’ experience working as a pharmacist in a PBM setting
Demonstrated prior authorization experience
Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable
Keyboard skills essential
Must be able to multitask and utilize multiple system applications simultaneously
Must be able to utilize available resources independently and provide high quality work
Must demonstrate problem solving ability and attention to detail
Ability to adapt and change with workflow and shifting priorities
Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the PA team
Must possess excellent written, verbal, grammar, and listening communication skills
Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner
Ability to maintain confidentiality of PHI (Protected Health Information)

Responsibilities

Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design
Verify insurance coverage and eligibility, interpret clinical guideline criteria, consult physicians and other healthcare providers, and appropriately utilize clinical knowledge and resources
Guarantee that decisions regarding cases are conveyed promptly and efficiently to all healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval and denial management processes
Collaborate with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews
Perform and handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations
Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Commercial Specialty Prior Authorization line of business
Perform other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed

Skills

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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