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POSITION SUMMARY :

As an RPh Operations Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by 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. This may be expanded to our Medicare Part B business.

PRIMARY DUTIES AND RESPONSIBILITIES

Ensure accuracy of case setup and clinical review of Medicare appeals cases

• Review internal notes or fax requests thoroughly for pertinent information
• Provide clear, concise, and accurate documentation for case reviews
• Contacting providers, if needed, for clinical information to decision cases
• Utilize work instructions and Medicare guidelines for accurate case processing

Comply with CMS mandated timelines and department productivity and quality standards

Acquire and utilize clinical judgement and knowledge, drug compendia resources, relevant and changing work instructions, and CMS Medicare guidance

Participate in development discussions receiving feedback from direct supervisor

Required Qualifications

Active pharmacist license in the state of residence that is in good standing

3+ years experience in Managed Care/PBM environment (Medicare experience preferred)

Flexibility with working a rotating schedule including overtime, weekends, and holidays

Excellent oral and written communication skills

Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment

Preferred Qualifications

Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome

Must be able to work independently and utilize critical thinking/problem solving skills to make case decisions

Receptive to constructive feedback and flexible in adapting to change

Education

Bachelors of Science - Pharmacy or Pharm.D.

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits