Job Abstract

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.

Job Summary:  CIC support staff is responsible for assisting in the resolution of rejected clinical claims management (Prior Authorizations and Covered Alternative Recommendations)

Key Responsibilities:

• Work rejected real-time claims for all pharmacies supported by the CIC under the direction of the CIC pharmacists.
  • Make phone calls to insurance plans.
  • Work with local pharmacies to meet run times and ensure timely dispensing of medications.
  • Work with facility staff to gather pertinent information needed to secure overrides/prior authorizations.
• Reconcile facility responses via online communication portal.
• Initiates Prior Authorization and obtain pertinent information from facility/prescribers as directed by a CIC pharmacist or Clinical Specialist.
• Call insurance plans to follow-up on submitted prior authorizations in timely manner
• Communicate with CIC and local pharmacy staff regarding the outcomes of the prior authorization requests and in the case of prior authorization denials work with pertinent staff to take the appropriate next steps in the resolution of the rejection
• Communicate any changes in prior authorization criteria or issues related with various insurance plans and processors to management team.
• Scan and send new or authorized orders to the appropriate destination
• Track all claim detail, activity, and outcome, as directed
• Review relevant CIC reports and handle accordingly
• Cross train for coverage of other positions in the CIC
• Follow all applicable government regulations including HIPAA.
• Display behavior which exemplifies employee code of conduct guidelines.
• Other duties as assigned; Job duties may vary by location.

**Registered Pharmacy Technician with California Board of Pharmacy required

Our organization offers a competitive benefit package including vacation paid time off, holiday/sick time,health/dental/vision insurance,work/life balance,employee discounted stock purchase program, 401K, tuition reimbursement, and employee discounts at all CVS stores

Minimum (Required) Qualifications: (must be met in order to perform the job at the required level)

• Healthcare experience
• Must possess excellent communication and interpersonal skills. 
• Must be flexible with regards to work schedule.

Preferred Qualifications: (if above and beyond the minimum required)

• Long term care or other medical environment, but not required
• State and/or Nationally Certified Pharmacy Technician preferred

Physical Demands: May sit, stand, stoop, bend and walk intermittently during the day. May sit or stand seven (7) to ten (10) hours per day. May be necessary to work extended hours as needed. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Visual acuity to see and read fine prints. Specific vision abilities required by this role include close vision, color vision and the ability to adjust focus. Must be able to hear normal voice sounds. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role.

Work Environment: Work in a climate-controlled, smoke-free internal environment.

Pay Range

The typical pay range for this role is:

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.  
 
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 jobs.CVSHealth.com/benefits