[Remote] RPh Operations Advisor - Med D at CVS Health

Texas Twp, Michigan, United States

CVS Health Logo
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, PharmaceuticalsIndustries

Requirements

Candidates must possess an active and unencumbered pharmacist license in their state of residence, along with current experience as a clinical pharmacist reviewing Medicare Part D requests within a Caremark PBM environment. Proficiency in utilizing multiple software systems simultaneously on a dual-screen workstation, including Windows-based operations, AS400, MHK, PeopleSafe, WI database, and Microsoft Office applications, is required. A typing speed of 30 WPM or greater, excellent oral and written communication skills, and the ability to multitask, prioritize, and manage time effectively in a fast-paced, highly regulated environment are essential. Candidates must be able to review large volumes of information, discern importance, apply clinical knowledge for outcomes, work independently, utilize critical thinking and problem-solving skills for case decisions, and be receptive to feedback and adaptable to change. Flexibility with a rotating schedule including overtime, weekends, and holidays is necessary, along with a dedicated, secure, and uninterrupted home workspace with stable, hard-wired high-speed internet. A BS in Pharmacy or PharmD and 3+ years of experience in a Managed Care/PBM environment are preferred.

Responsibilities

The RPh Operations Advisor will directly support Medicare Part D members and providers with requests concerning their pharmacy benefits. Key responsibilities include accurately setting up cases for members, reviewing clinical information for decision-making, performing outreach to providers for additional information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This role involves reviewing information and completing timely and accurate documentation of all Medicare Part D requests in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Skills

Pharmacist License
Medicare Part D
Pharmacy Benefits
Clinical Review
PBM
AS400
MHK
PeopleSafe
Microsoft Office
Typing (30 WPM)
Communication
Multi-tasking
Time Management

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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