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About the Role
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Responsibilities
- Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests.
- Promotes and supports quality effectiveness of healthcare and Pharmacy Services.
- Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines.
- Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria.
- Determines appropriateness for medications and communicates decisions to physicians, physician’s office staff, medical management staff, members, and/or pharmacists.
- Performs clinical research to support requests.
- Performs non-medical research including eligibility verification, COB, and benefits verification.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Processes requests in compliance with various laws and CMS regulations and company policies and procedures.
- May communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers.
- Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services.
- Performs sedentary work involving significant periods of sitting, talking, hearing, and keying.
- Escalates requests to Pharmacist when request requires extensive clinical review or denial.
Requirements
- National Pharmacy Technician certification and Home State License, current and in good standing, are required.
- Proficiency in computerized pharmacy systems and software applications.
- Excellent verbal and written communication skills.
- Experience with Windows-based software applications.
- Utilizes various proprietary systems to build, research, process and enter requests.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Work Type
- Full time
Education Level
- High School diploma, G.E.D.
Salary/Compensations
- $18.50 - $35.29 per hour
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
About the Company
- Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Equal Opportunity
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.