RPh Operations Advisor – Med D

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

📋 Description

• Provide direct assistance to Medicare Part D members and providers regarding pharmacy benefit inquiries.

• Efficiently establish cases for members.

• Evaluate clinical information to make informed decisions on requests.

• Conduct outreach to providers for additional details as necessary.

• Ensure that accurate decisions are made in accordance with compendia, Medicare guidelines, and timelines.

• Review information and complete precise documentation of Medicare Part D requests, adhering to Medicare standards.

• Foster a top-tier service experience.

⛳️ Requirements

• Possess an active pharmacist license in the state of residence that is in good standing.

• Current experience as a clinical pharmacist reviewing Med D requests in a Caremark PBM setting.

• Capability to operate multiple software systems concurrently, utilizing a dual-screen workstation with 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.

• Proficient in multi-tasking, prioritizing, and managing time efficiently in a dynamic, highly regulated environment.

• Skilled in reviewing substantial amounts of information, assessing significance, and applying clinical expertise to support outcomes.

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

• Open to constructive criticism and adaptable to change.

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

• A dedicated, quiet, and secure home workspace that is free from unintended access and not subject to common foot traffic.

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

• Bachelor’s degree in Pharmacy or PharmD.

• Preferably 3+ years of experience in a Managed Care/PBM environment.

🏝️ Benefits

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

• Health insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources that support physical, emotional, and financial well-being, based on eligibility.