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 pharmacy benefit inquiries.

• Accurately establish member cases.

• Evaluate clinical data to make informed request decisions.

• Conduct outreach to providers for additional information as necessary.

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

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

• Foster a best-in-class service experience.

⛳️ Requirements

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

• Current experience as a clinical pharmacist assessing Medicare Part D requests within a Caremark PBM setting.

• Proficient in using multiple software systems simultaneously with a dual-screen workstation setup.

• Familiarity with Windows-based operations, AS400, MHK, PeopleSafe, WI database, and Microsoft Office applications.

• Typing speed of 30 WPM or higher.

• Exceptional oral and written communication abilities.

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

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

• Ability to work independently while utilizing critical thinking and problem-solving skills for case decisions.

• Openness to constructive feedback and adaptability to change.

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

• Dedicated, quiet, uninterrupted, and secure home workspace.

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

• Preferred: 3+ years of experience in a Managed Care/PBM setting.

• 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.