RPh Advisor - Medicare Part D

About the position Responsibilities • Ensure accuracy of case setup and clinical review of Medicare appeals cases • Review internal notes or fax requests thoroughly for pertinent information • Provide clear, concise, and accurate documentation for case reviews • Contact providers for clinical information to decision cases when needed • Utilize work instructions and Medicare guidelines for accurate case processing • Comply with CMS mandated timelines and department productivity and quality standards • Acquire and utilize clinical judgement and knowledge, drug compendia resources, and CMS Medicare guidance • Participate in development discussions receiving feedback from direct supervisor. Requirements • Active pharmacist license in the state of residence that is in good standing • Current experience working within Caremark PA Ops • Current experience with Medicare Part D cases • Demonstrated ability to utilize multiple software systems simultaneously with a 2-screen workstation setup • Ability to type 30 WPM or greater • Demonstrated ability to utilize compendia (Micromedex, Lexicomp, etc) to evaluate and support case decisions • Excellent oral and written communication skills • Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment • Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome • Demonstrated ability to work independently and utilize critical thinking/problem solving skills to make case decisions • Receptive to constructive feedback and flexible in adapting to change • Flexibility with working a rotating schedule including overtime, weekends, and holidays Nice-to-haves • PGY1 Residency Benefits • Full range of medical, dental, and vision benefits • 401(k) retirement savings plan • Employee Stock Purchase Plan • Fully-paid term life insurance plan • Short-term and long-term disability benefits • Well-being programs • Education assistance • Free development courses • CVS store discount • Discount programs with participating partners • Paid Time Off (PTO) or vacation pay • Paid holidays throughout the calendar year Apply tot his job Apply To this Job