Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

The Representative I, Clinical Services takes in-bound calls from providers, pharmacies, and members etc,, providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews.  Transfers all clinical questions, escalations and judgement calls to the pharmacist team.

 

The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.

Required Qualifications

- Ability to apply basic computer skills.   

- Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. 

- Keyboard skills are essential.

- Must be able to multitask and utilize multiple system applications simultaneously.  

- Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.

Preferred Qualifications

- Prior authorization experience

- Must be able to utilize available resources independently and provide high quality work.

- Must be able to absorb presented information, display motivation, seek development and problem solve.

- Ability to adapt and change with workflow and shifting priorities.

- Must possess excellent written, verbal, grammar, and listening communication skills.

- Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.

- Ability to maintain confidentiality of PHI (Protected Healthcare Information).

- Associate Degree or Bachelor’s Degree

Education
 

High School diploma or equivalent GED

 

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 10/01/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.