Clinical Pharmacy Support Technician (WFH Anywhere in the U.S.)

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.Work From Home Remote Position Anywhere in the United States
A Brief OverviewAdministers operational support to clinical pharmacy staff. Conducts outreach to providers, pharmacists, case managers, and members. Supports day-to-day processes, reviews data, and documents relevant interactions.Position SummaryPrimary responsibility is supporting Formulary Alternative Outreach Program for Medicare Part D. The Clinical Support Technician will support the operations of the Retro DUR (Drug Utilization Review)/Scorable Action Items (SAI) Clinical Pharmacy staff. This will include outreach calls and faxes to providers, pharmacists, case managers and members, managing day to day processes, analyzing data and organizing and documenting all relevant interactions.

• Executes both routine and non-routine business support tasks for the Clinical Pharmacy Support area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Conducts review to ensure members receive the appropriate therapy as approved by the provider, determines therapy timelines, and determines claim appropriateness.
• Initiates education for providers and pharmacies on medication options, enhancements, and alternative therapy options for members.
• Communicates with pharmacies to verify claim information and reverse unnecessary claims.
• Takes direction to execute techniques, processes, and responsibilities.
• Working knowledge of problem solving and decision making skills
• 4+ years work experience
• Responsible for reviewing overutilization data and making prescriber and or pharmacy outreach which includes reviewing formulary vs. non-formulary prescription clinical/pharmacy protocol. Ensure member is receiving the appropriate therapy as approved by the provider and determine length of therapy and establish if current claims are appropriate. Educate providers and pharmacies on formulary vs. non-formulary medications and options for alternative therapies for members. Educates Case Managers on opportunities to enhance medication utilization of members. Review therapeutic duplication data and contact providers and pharmacies to establish correct therapy for member and reverse any unnecessary RX claims while working with pharmacist. Responsible for prescriber outreach for specific Scoreable Action Item initiatives. Work with team Pharmacist to investigate specific cases of overutilization including potential member outreach to ensure member has received products that have been
  
  dispensed under plan. Maintain expert knowledge in most areas of pharmacy operations. Ability to analyze and interpret various types of complex claim data under member plans. Work with Pharmacy to verify claims information and reverse unnecessary claims. Identify opportunities for improvement in departmental and pharmacy operations with recommendations for modes of resolution. Train, coach, and mentor new Clinical Support Technician Staff.Work from Home:
  • Work From Home: Monday - Friday
  Schedule: Monday - Friday; 8:00a - 5:00p local timeRequired Qualifications
  • 4 or more years relevant experience
  • Valid Pharmacy Technician Certification (PTCB or ExCPT)
  • Working knowledge of Microsoft Outlook and Teams
  • Ability to interpret Pharmacy Claims data
  • Proficiency in computerized pharmacy systems and software applications
  • Previous provider/pharmacy outreach experience
  • Ability to perform duties with minimal supervision
  • Proficient knowledge of Brand/Generic drug names
  Preferred Qualifications
  • Managed Care experience
  • Advanced knowledge of Microsoft Excel and Microsoft Access
  • Understanding of medical and pharmacy terminology
  Education
  • High School Diploma or equivalent

• 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.