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CVS Health Senior Clinical Representative - Med D in Texas

Job Description

As a Clinical Senior Representative, you will work closely with healthcare providers to process Prior Authorizations (PA) and drug benefit exception requests in a call center or fax environment. In this role, you will play a meaningful role in ensuring member and client satisfaction. You will be performing all work in accordance with Medicare Part D guidelines. In this role, you would have flexibility to work anyshift between 7:00am - 8:00pm (Monday -Friday) and weekend hours on a rotation.As a Clinical Senior Representative, you'll show a high level of attention to detail, verbal and written communications skills, and the ability to problem solve in this dynamic work environment. You’ll be working various assignments that require demonstrated urgency and the ability to meet set timelines. You’ll have the opportunity to project a professional business image through all interactions.The Senior Rep will be responsible for assisting the supervisor team with managing the IBC phone chat and ensuring all phone service levels are met or could be assisting colleagues with questions regarding Fax requests. Time will be divided between working on the phones taking member calls or working in the production queues, and assisting the supervisors and resource planning team with leading the virtual team.Your responsibilities will include but not be limited to:- Working incoming cases via phone or fax to process coverage requests frommembers or prescribers.- Conducting outreach to patients and providers, and obtaining additional information needed to process requests.- Researching and correcting any issues found in the overall process.- Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed.- Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations.- Solving practical problems and dealing with multiple concrete variables in standardized situations.- Performing basic mathematical calculations.- Ensuring all cases are properly closed.- Ability to interpret a variety of work instructions provided through multiple mediums.- Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards.- Schedule flexibility including rotations through Nights, Weekend and Holiday Coverage.- Assisting the management team and sometimes acting as a leader during supervisor or leadership absences.

Required Qualifications

As a Clinical Senior Representative, you will work closely with healthcare providers to process Prior Authorizations (PA) and drug benefit exception requests in a call center or fax environment. In this role, you will play a meaningful role in ensuring member and client satisfaction. You will be performing all work in accordance with Medicare Part D guidelines. In this role, you would have flexibility to work anyshift between 7:00am - 8:00pm (Monday -Friday) and 800-1630 rotating weekends.As a Clinical Senior Representative, you'll show a high level of attention to detail, verbal and written communications skills, and the ability to problem solve in this dynamic work environment. You’ll be working various assignments that require demonstrated urgency and the ability to meet set timelines. You’ll have the opportunity to project a professional business image through all interactions.The Senior Rep will be responsible for assisting the supervisor team with managing the IBC phone chat and ensuring all phone service levels are met or could be assisting colleagues with questions regarding Fax requests. Time will be divided between working on the phones taking member calls or working in the production queues, and assisting the supervisors and resource planning team with leading the virtual team.Your responsibilities will include but not be limited to:- Working incoming cases via phone or fax to process coverage requests frommembers or prescribers.- Conducting outreach to patients and providers, and obtaining additional information needed to process requests.- Researching and correcting any issues found in the overall process.- Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed.- Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations.- Solving practical problems and dealing with multiple concrete variables in standardized situations.- Performing basic mathematical calculations.- Ensuring all cases are properly closed.- Ability to interpret a variety of work instructions provided through multiple mediums.- Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards.- Schedule flexibility including rotations through Nights, Weekend and Holiday Coverage.- Assisting the management team and sometimes acting as a leader during supervisor or leadership absences.Required Qualifications :1+ year experience at CVS Health.- 6+ months of Coverage Determination and Appeals experience.- 6+ months in a leadership role or Learning Advocate role.- Completion of the Learning Advocate Training Certification Program.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

Experience Pharmacy or PBM environment.- Experience in a role requiring maintenance of patient confidentiality

Education

Verifiable High School Diploma or GED required.

Business Overview

At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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