Phoenix, Georgia

Job Description
- Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests. Promotes and supports quality effectiveness of healthcare and Pharmacy Services. Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines.
- Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria. Determines appropriateness for medications. Communicates decision to physicians, physician’s office staff, medical management staff, members, and/or pharmacists.
- Will perform clinical research to support request.
- Performs non-medical research including eligibility verification, COB, and benefits verification.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Process requests in compliance with various laws and CMS regulations and company policies and procedures.
- May communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers
- Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services.
- Sedentary work involving significant periods of sitting, talking, hearing, and keying.
- Escalates requests to Pharmacist when request requires extensive clinical review or denials.

Required Qualifications
- National Pharmacy Technician certification and Arizona and/or Texas State License, current and in good standing, are required.

- Proficiency in computerized pharmacy systems and software applications.
- Excellent verbal and written communication skills.
- Experience with Windows-based software applications.
- Utilizes various proprietary systems to build, research, process and enter requests.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.


Preferred Qualifications
- High volume call center and production unit.
- Experience in retail, hospital, facility or call center is preferred.

Education
High School diploma, G.E.D.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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. See Job Description

Phoenix, Georgia

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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