directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits
responsible for ensuring cases are accurately set up for our members
review clinical information for decisioning the request
performing outreach to providers for more information when needed
ensuring accurate decisions that comply with compendia and Medicare guidance and timelines
completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

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
Demonstrated ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, 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
Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome
Must be able 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 home workspace needed. Must be able to provide a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional access. Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet).

RPh Operations Advisor – Med D

Key skills