RPh Operations Advisor - Aetna Medical Prior Authorizations

Description: • Clinical Pharmacist with the Specialty Medical Prior Authorization team conducts reviews of medical data collected to perform prior authorization review for specialty medications. • Applies clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. • This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations. • Operational hours are 8am-7pm CT, and we are seeking a candidate who is able to work 9am-6pm CT. Rotating weekends and occasional holidays may be required per business needs. The position is fully remote. • We offer a competitive benefit package including vacation, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at all CVS stores. 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 • Excellent interpersonal skills • Demonstrate 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 • Follows all prior authorization procedures to ensure a timely and accurate process on each prior authorization • 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. Benefits: • Competitive benefits package including vacation, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at CVS stores. • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions addressing paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and many other benefits depending on eligibility. • For more information, visit https://jobs.cvshealth.com/us/en/benefits Apply tot his job Apply To this Job