RPh Operations Advisor - Aetna Medical Prior Authorizations

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Are you ready to take your clinical skills to the next level? Check out this outstanding opportunity for a Clinical Pharmacist with the Specialty Medical Prior Authorization team! The Clinical Pharmacist is an operations based role that conducts reviews of medical data collected to perform prior authorization review for specialty medications. The Clinical Pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations. Operational hours are 8am-7pm CT, and we are seeking a candidate who is able to work 9am-6pm CT. Rotating weekends and occasional holidays may be required per business needs. The position is fully remote. We offer a competitive benefit package including vacation, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at all CVS stores. Required Qualifications - Active pharmacist license in state of residence in good standing - 2+ years clinical pharmacist experience - 1+ years demonstrated experience issuing clinical determinations within Prior Authorizations - Current experience working within the Novologix system, specifically Aetna Medical Prior Authorization Operations - Current experience issuing clinical determinations within Aetna Medical PA Preferred Qualifications Excellent interpersonal skills Demonstrate problem solving ability and attention to detail Ability to work effectively in a team environment with great dependability Excellent oral and written communication skills Ability to quickly assess and adapt to constantly changing situations Required to possess a high mental agility and alertness Ability to effectively communicate with pharmacists, other clinical colleagues, healthcare professionals, and members Ability to effectively prioritize work while exhibiting a high level of urgency with all calls and assignments Follows all prior authorization procedures to ensure a timely and accurate process on each prior authorization Ability to effectively train and mentor representatives on the PA team Call center, PBM, or clinical experience Strong Microsoft Office skills Experience utilizing CAS, Novologix, Sales Force, RxClaim, and PeopleSafe. Education Bachelor of Pharmacy or PharmD Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $45.43 - $93.08 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 08/17/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. Apply tot his job Apply To this Job