RPh Operations Advisor – Med D

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

📋 Description

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

• Accurately establish cases for members.

• Evaluate clinical data to make informed decisions on requests.

• Conduct outreach to providers for supplementary information when necessary.

• Ensure that decisions are accurate and align with compendia, Medicare guidelines, and mandated timelines.

• Review documentation and ensure timely, precise recording of Medicare Part D requests.

• Foster a premier service experience.

⛳️ Requirements

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

• Current experience as a clinical pharmacist reviewing Med D requests within a Caremark PBM environment.

• Capability to utilize various software systems concurrently 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.

• Exceptional oral and written communication skills.

• Proficiency in multi-tasking, prioritizing, and managing time effectively in a fast-paced, highly regulated setting.

• Capacity to review extensive volumes of information, assess significance, and apply clinical knowledge to support outcomes.

• Ability to work independently and apply critical thinking/problem-solving skills to make case decisions.

• Openness to constructive feedback and adaptability to change.

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

• Designated home workspace that is quiet and free from interruptions.

• Workstation must not be accessible to general traffic and should be secured from unintentional access.

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

• Preferred: More than 3 years of experience in a Managed Care/PBM environment.

• Bachelor of Science in Pharmacy or PharmD.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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