RPh Operations Advisor – Medical Prior Authorizations

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

📋 Description

• Conduct evaluations of medical data to execute prior authorization reviews for specialty medications.

• Utilize clinical expertise and established criteria during prospective and concurrent case evaluations.

• Employ CVS Caremark-supported systems for processing prior authorizations.

• Handle incoming calls from physicians or members concerning pending, approved, or denied prior authorizations.

• Adhere to operational hours from 8am–7pm CT.

• Participate in rotating weekends and occasional holidays as dictated by business needs.

• Issue clinical determinations within Aetna Medical Prior Authorization Operations.

• Follow established prior authorization procedures to guarantee timely and precise processing.

• Train and mentor team members within the prior authorization department.

• Liaise with pharmacists, clinical colleagues, healthcare professionals, and members.

• Prioritize calls and tasks with a high degree of urgency.

⛳️ Requirements

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

• Minimum of 2 years of experience as a clinical pharmacist.

• At least 1 year of proven experience in issuing clinical determinations within prior authorizations.

• Current experience with the Novologix system, particularly in Aetna Medical Prior Authorization Operations.

• Recent experience in issuing clinical determinations within Aetna Medical Prior Authorization.

• Excellent interpersonal abilities.

• Strong problem-solving skills and meticulous attention to detail.

• Capacity to work effectively within a team environment and demonstrate reliability.

• Exceptional oral and written communication skills.

• Ability to assess and adapt swiftly to changing scenarios.

• High mental agility and alertness.

• Proficient in effectively communicating with pharmacists, clinical colleagues, healthcare professionals, and members.

• Skilled in prioritizing tasks while maintaining urgency in calls and assignments.

• Capability to train and mentor representatives on the prior authorization team.

• Experience in call center, PBM, or clinical settings.

• Strong skills in Microsoft Office.

• Familiarity with CAS, Novologix, Sales Force, RxClaim, and PeopleSafe.

• Bachelor of Pharmacy or PharmD required.

• Availability to work from 8am–7pm CT.

• Willingness to work rotating weekends and occasional holidays as needed.

🏝️ 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.