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RPh Operations Advisor – Med D
CVS Health. Directly support Medicare Part D members and providers with requests related to pharmacy benefits .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare Part D processes, clinical pharmacy decision-making, and compliance with regulatory guidelines. Proficient in utilizing multiple software systems to manage pharmacy benefit requests efficiently while providing exceptional service to members and providers.
Highest-signal resume keywords
Active Pharmacist LicenseClinical Pharmacy ExperienceMedicare Part D KnowledgeSoftware Proficiency (Windows, AS400, MHK, PeopleSafe)Critical Thinking Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewCase SetupDocumentation AccuracyTyping Speed (30 WPM)Information Analysis
Soft Skills
Excellent Communication SkillsTime ManagementMulti-tasking AbilityAdaptabilityReceptiveness to Feedback
Tools & Technologies
Microsoft OfficeWindows Operating SystemAS400MHKPeopleSafe
Certifications & Qualifications
BS in PharmacyPharmD
Industry Keywords
MedicarePharmacy Benefits Management (PBM)Managed CareRegulatory ComplianceClinical Decision-Making
About the role
Key responsibilities & impact- Directly 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
- Perform 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 in compliance with Medicare guidelines
- 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 Caremark 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 multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment
- Ability to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome
- 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
- Dedicated, quiet, uninterrupted home workspace that is secure from unintentional access and not accessible to common traffic
- Stable personal high-speed internet with ability to hard-wire into company computer; wireless internet cannot be used
- BS in Pharmacy or PharmD
- 3+ years experience in Managed Care/PBM environment (preferred)
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, based on eligibility