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.
Our organization offers a competitive benefit package including vacation, holiday/sick time, health/dental/vision insurance, work/life balance, employee discounted stock purchase program, 401K, tuition reimbursement, and employee discounts at all CVS stores.
Join the company helping people and their path to better health!
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Active Pharmacy Technician License
Ability to deal with a diverse customer base in a friendly and confident manner (internal and external customers). Proficient with computer systems and Microsoft Office skills, including Access, Excel and Word. Ability to navigate systems in Windows and web-based programs, and quickly learn new applications. Ability to prioritize and manage multiple tasks. Demonstrated sense of urgency with assignments. Excellent organization skills. Strong detail orientation.
Demonstrated problem-solving ability. Strong verbal and written communication skills. Ability to maintain confidentiality. Knowledge of claim adjudication processes. Works well as a member of a team with strong interpersonal skills. Seeks ways to collaborate and reach consensus with peers. Actively works to build strong working relationships.
Able to customize messages and deliver to broader audiences. Background in creating and maintaining reports a plus.
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
-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
-Call center experience a plus
Verifiable High School Diploma or GED - Required
Associates Degree or Bachelors Degree - Preferred
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.