Clinical Review Pharmacist (Seasonal)
SmithRxSalary not specified
Full Time
Mid-level (3 to 4 years)
RPh Operations Advisor - Aetna Medical Prior Authorizations at CVS Health
Texas Twp, Michigan, United States
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Pharmaceuticals, InsuranceIndustries
Requirements
Candidates must possess an active pharmacist license in their state of residence, have at least 2 years of clinical pharmacist experience, and at least 1 year of experience issuing clinical determinations within Prior Authorizations. Current experience working within the Novologix system, specifically Aetna Medical Prior Authorization Operations, and issuing clinical determinations within Aetna Medical PA is required. A Bachelor of Pharmacy or PharmD is required, along with strong Microsoft Office skills and the ability to quickly assess and adapt to changing situations. High mental agility, alertness, and excellent oral and written communication skills are also necessary.
Responsibilities
The Clinical Pharmacist will conduct reviews of medical data to perform prior authorization reviews for specialty medications, applying clinical knowledge to plan approved criteria for prospective and concurrent reviews. They will utilize CVS Caremark supported systems, take inbound calls from physicians or members regarding prior authorizations, and follow all prior authorization procedures to ensure a timely and accurate process. This role may also involve training and mentoring representatives on the PA team.
Skills
Pharmacist License
Clinical Pharmacist Experience
Prior Authorizations
Clinical Determinations
Novologix System
Aetna Medical Prior Authorization Operations
Medical Data Review
Specialty Medications
Prospective Review
Concurrent Review
Inbound Calls
Physician Communication
Member Communication
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