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.
1. Able to apply basic computer skills. Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.
2. Basic pharmaceutical knowledge pertaining to terminology, calculations and protocols.
3. Must be able to utilize available resources independently and provide high quality work. Must be able to absorb
presented information, display motivation, seek development and problem solve.
4. Abillity to adapt and change with workflow and shifting priorities.
5. Must possess excellent written, verbal, grammar, and listening communication skills.
6. Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
7. Ability to maintain confidentiality of PHI (Protected Healthcare Information).
-Previous Healthcare Experience and/or Managed Care experience
-Previous Customer Service Experience
-Call Center Experience is a plus
-Excellent written and Verbal Communication Skills
-Ability to efficiently learn external software programs and multitask between several computer applications
Verifiable High School Diploma or GED
Resident state Pharmacy Technician License and applicable Certification.
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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