RPh Operations Advisor – Med D

This is a fully remote position, open to applicants in Texas.

📋 Description

• Assist Medicare Part D members and healthcare providers with inquiries regarding pharmacy benefits.

• Precisely establish cases for members.

• Analyze clinical information to make informed decisions on requests.

• Reach out to providers for further information when necessary.

• Ensure that decisions align with compendia and Medicare guidelines and timelines.

• Review data and ensure timely, accurate documentation of Medicare Part D requests.

• Foster a top-tier service experience.

⛳️ Requirements

• A valid pharmacist license in the state of residence, in good standing.

• Current experience as a clinical pharmacist evaluating Med D requests within a PBM setting.

• Proficiency in using multiple software systems simultaneously with a dual-screen workstation setup, including Windows-based operations, AS400, MHK, PeopleSafe, WI database, and Microsoft Office applications.

• Ability to type at least 30 words per minute.

• Strong oral and written communication skills.

• Capability to multitask, prioritize, and effectively manage time in a fast-paced and highly regulated environment.

• Competence in reviewing large volumes of information, assessing relevance, and applying clinical knowledge to support outcomes.

• Ability to work autonomously and employ critical thinking/problem-solving skills for case decisions.

• Open to constructive feedback and adaptable to change.

• Willingness to work a rotating schedule that includes overtime, weekends, and holidays.

• A dedicated home office space that is quiet, uninterrupted, and secure.

• Reliable personal high-speed internet connection with the ability to hard-wire into the company computer; wireless internet is not permitted.

• Over 3 years of experience in a Managed Care/PBM environment is preferred.

• Bachelor of Science in Pharmacy or PharmD.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Dedicated home workspace arrangement.