RPh Operations Advisor – Med D

CVS Health

. Support Medicare Part D members and providers with requests related to pharmacy benefits .

Posted 10/8/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $50 - $85 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in reviewing Medicare Part D requests and clinical information within a PBM environment, ensuring compliance with regulations while providing exceptional service. Proficient in utilizing multiple software systems and managing time effectively in a fast-paced setting.

Highest-signal resume keywords

Active Pharmacist LicenseClinical Pharmacist ExperienceMedicare Part D KnowledgeSoftware Proficiency (AS400, MHK, Microsoft Office)Critical Thinking Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pharmacy Benefits ManagementCase Setup and ReviewDocumentation AccuracyClinical Decision MakingTyping Speed (30 WPM or Greater)

Soft Skills

Excellent Communication SkillsMultitasking AbilityTime ManagementReceptiveness to FeedbackFlexibility

Tools & Technologies

Windows-Based OperationsAS400MHKPeopleSafeWI Database

Certifications & Qualifications

BS in PharmacyPharmD

Industry Keywords

Medicare Part DManaged CarePBM EnvironmentRegulatory ComplianceClinical Knowledge

About the role

Key responsibilities & impact

Support Medicare Part D members and providers with requests related to pharmacy benefits
Accurately set up cases for members
Review clinical information to make decisions on requests
Conduct outreach to providers for additional information when needed
Ensure accurate decisions comply with compendia and Medicare guidance and timelines
Review information and complete timely, accurate documentation of Medicare Part D requests
Promote a best-in-class service experience

Requirements

What you’ll need

Active pharmacist license in the state of residence that is in good standing
Current experience as clinical Pharmacist reviewing Med D requests within PBM environment
Ability to utilize multiple software systems simultaneously with a 2-screen workstation setup, including Windows-based operations, AS400, MHK, PeopleSafe, WI database, and Microsoft Office applications
Ability to type 30 WPM or greater
Excellent oral and written communication skills
Ability to multitask, prioritize, and manage time effectively in a fast-paced, highly regulated environment
Ability to review large volumes of information, determine importance, and apply clinical knowledge to assist in outcomes
Ability to work independently and use critical thinking/problem-solving skills to make case decisions
Receptiveness to constructive feedback and flexibility in adapting to change
Flexibility to work a rotating schedule including overtime, weekends, and holidays
Dedicated home workspace with a quiet, uninterrupted, secure environment
Stable personal high-speed internet and ability to hard-wire into the company computer; wireless internet cannot be used
3+ years of experience in a Managed Care/PBM environment preferred
BS in Pharmacy or PharmD

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
Dedicated home workspace arrangement