RPh Operations Advisor – Medical Prior Authorizations

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

📋 Description

• Perform evaluations of medical data to carry out prior authorization assessments for specialty medications.

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

• Operate within the systems supported by CVS Caremark.

• Receive inbound inquiries from physicians or members regarding pending, approved, or denied prior authorizations.

• Generate clinical determinations as part of the Aetna Medical Prior Authorization operations.

• Adhere to prior authorization protocols to guarantee timely and precise processing.

• Provide training and mentorship to representatives on the PA team as necessary.

⛳️ Requirements

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

• A minimum of 2 years of clinical pharmacist experience.

• At least 1 year of proven experience in issuing clinical determinations in Prior Authorizations.

• Current familiarity with the Novologix system, particularly within Aetna Medical Prior Authorization Operations.

• Recent experience in making clinical determinations within Aetna Medical PA.

• Bachelor of Pharmacy degree or PharmD.

• Availability to work from 8 AM to 7 PM CT.

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

• Strong interpersonal capabilities.

• Effective problem-solving skills and attention to detail.

• Ability to collaborate efficiently in a team setting with high reliability.

• Exceptional oral and written communication abilities.

• Capacity to swiftly assess and adjust to rapidly changing circumstances.

• High mental agility and alertness.

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

• Skill in prioritizing tasks with a strong sense of urgency.

• Capability to train and mentor representatives on the PA team.

• Strong skills in Microsoft Office applications.

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

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

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• CVS Health bonus, commission, or short-term incentive program.