At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.POSITION SUMMARY: As an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. In addition, as an Oncology Pharmacist you will assist front-line colleagues (i.e. Staff Pharmacists and Representatives) with oncology process/procedural support by acting as a subject matter expert and performing any other complex tasks or addressing any escalation cases assigned by leadership. This includes providing on-the-job (OJT) training, answering questions from front-line colleagues, production support, and providing recommendations/solutions to effectively streamline systems and processes. The Pharmacist will be responsible for maintaining the most current oncology therapy knowledge through self-education, continuing education and certification. This position also supports departmental leadership in identifying issues, concerns and trends within the workflow process. The Pharmacist will partner with our Lead Oncology Pharmacist to help develop/deliver formal clinical training sessions, delivering them to staff to enhance their clinical knowledge base in relation to the oncology disease states and therapies. Strong effective communication is required to ensure the thorough distribution, understanding and execution of required knowledge transfer to internal and external stakeholders. The Pharmacist will be expected to work closely with other teams and departments throughout the company including Case Review Unit (CRU), Commercial PA & appeals, internal Medical Directors, Clinical Development, and our Client Liaison team.This is a work-from-home role open to qualified candidates within the United States. Candidate must be willing and able to work 9am-5:30pm EST M-F, with the ability to flex to later or earlier if needed for training, client meetings, or other business needs.
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PRIMARY DUTIES AND RESPONSIBILITIES:
1. Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design with a focus on oncology reviews. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes.
% Time: 70%
2. A Leader in identifying and solving issues, concerns and trends within the workflow process that need to be addressed at a higher level resulting in optimal performance and outcomes. Responsible for assisting front-line colleagues (i.e. Staff Pharmacists and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership.
% Time: 20%
3. Assist with standard or client specific oncology review process changes as needed.
% Time: 5%
4. Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients.
% Time: 5%EDUCATION
BS in Pharmacy or PharmD
Required: Licensed Pharmacist and Board Certified Oncology Pharmacist (BCOP)REQUIRED SKILLS & OTHER MINIMUM REQUIRED QUALIFICATIONS:
• Active pharmacist license in the state of residence that is in good standing.
• Board Certified Oncology Pharmacist (BCOP) required
• 2+ years clinical pharmacist experience, inclusive of prior authorization experience
• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills
essential.
• Must be able to multitask and utilize multiple system applications simultaneously.
• Must be able to utilize available resources independently and provide high quality work.
• Must demonstrate problem solving ability and attention to detail.
• Demonstrated clinical expertise in the oncology therapy arena, with recent career focus in the oncology area.
• Ability to adapt and change with workflow and shifting priorities.
• Ability to work effectively in a team environment and provide mentorship to front line staff on the PA team.
• Must possess excellent written, verbal, grammar, and listening communication skills.
• Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident
manner.
• Ability to maintain confidentiality of PHI (Protected Health Information).ESSENTIAL FUNCTIONS:
1. Regular and predictable attendance.
2. Colleague will be required to work mandatory overtime/extended work week when needed.
3. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information
being provided to internal and external customers.
4. Adhere to all policies and procedures.
5. Attend on-going training and development meetings.
Physical Requirements:
1. Sits at desk for long periods of time.
2. Talking on phone for extended periods of time.
3. Computer use for extended periods of time.
4. Reading a computer screen.WORK ENVIRONMENT: Work from an approved work-from-home location. Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$45.43 - $101.54This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.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.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.