RPh Operations Advisor - CRU

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 :

The RPh Operations Advisor is an operation - based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure . The RPh Operations Advisor will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physician s or members regarding their pending, approved, or denied prior authorizations , internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA request as needed. PRIMARY DUTIES AND RESPONSIBILITIES :

• 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 .

• Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.

• Licensed Registered Pharmacist
• Current pharmacist experience within Case Review Unit (CRU)
• Ability and willingness to work a flexible hourly schedule to include overtime, weekends, and holidays as needed
• 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.
• Ability to adapt and change with workflow and shifting priorities.
• Ability to work effectively in a team environment and provide mentorship to non-clinical 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 Healthcare Information).

• 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.