This position provides processing and communication of Specialty medication prior authorization referrals reviewed by the Case Review Unit for the Specialty Guideline Management Programs. This position collaborates with Customer Service, Benefits Verification and Pharmacy Operations to communicate referral status and determinations. This position is also responsible for fax processing and providing telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Maintaining complete, accurate and timely documentation of all appropriate information is necessary. This position also works closely with the Case Review Unit Clinician team for clinical support on daily functions. Other duties may also be assigned by the leadership team.
PRIMARY DUTIES AND RESPONSIBILITIES:
1. Effectively and professionally handle work volume to process referrals via call and fax requests utilizing appropriate program criteria.
2. Accurate and timely documentation of data received from call and fax communications.
3. Communication with other internal groups regarding determination status and results.
4. Identify and elevate clinical inquiries to the Clinician Team.
5. Other duties as assigned – for example, Fax sorting, QC, email boxes, CAS maintenance, etc.
3+ months of data entry or phone experience
HS Diploma or GED
Resident state Pharmacy Technician License and applicable Certification, or proof of application prior to starting. License must be obtained within 30 days of start date.
M-F 7:00am - 6:00pm
Bachelor, Associate Degree preferred, or relevant years of work experience required.
Verifiable High School Diploma or GED
It's a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
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