RPh Advisor – Medicare Part D

About the position

The RPh Advisor – Medicare Part D role at CVS Health involves supporting Medicare Part D members and providers with pharmacy benefit requests. The advisor is responsible for ensuring accurate case setups, reviewing clinical information, and making compliant decisions in line with Medicare guidelines. This position offers an opportunity to start a career in a leading healthcare company, focusing on delivering a best-in-class service experience while adhering to regulatory standards.

Responsibilities
• Ensure accuracy of case setup and clinical review of Medicare appeals cases
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• Review internal notes or fax requests thoroughly for pertinent information
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• Provide clear, concise, and accurate documentation for case reviews
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• Contact providers for clinical information to decision cases when needed
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• Utilize work instructions and Medicare guidelines for accurate case processing
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• Comply with CMS mandated timelines and department productivity and quality standards
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• Acquire and utilize clinical judgement and knowledge, drug compendia resources, and CMS Medicare guidance
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• Participate in development discussions receiving feedback from direct supervisor.

Requirements
• Active pharmacist license in the state of residence that is in good standing
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• Current experience working within Caremark PA Ops
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• Current experience with Medicare Part D cases
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• Demonstrated ability to utilize multiple software systems simultaneously with a 2-screen workstation setup
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• Ability to type 30 WPM or greater
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• Demonstrated ability to utilize compendia (Micromedex, Lexicomp, etc) to evaluate and support case decisions
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• Excellent oral and written communication skills
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• Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment
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• Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome
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• Demonstrated ability to work independently and utilize critical thinking/problem solving skills to make case decisions
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• Receptive to constructive feedback and flexible in adapting to change
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• Flexibility with working a rotating schedule including overtime, weekends, and holidays

Nice-to-haves
• PGY1 Residency

Benefits
• Full range of medical, dental, and vision benefits
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• 401(k) retirement savings plan
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• Employee Stock Purchase Plan
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• Fully-paid term life insurance plan
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• Short-term and long-term disability benefits
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• Well-being programs
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• Education assistance
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• Free development courses
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• CVS store discount
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• Discount programs with participating partners
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• Paid Time Off (PTO) or vacation pay
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• Paid holidays throughout the calendar year