Clinical Pharmacy Support Technician - Remote Medicare Part D Operations - Anywhere in the U. S.

Join Our Team: Transforming Healthcare with CVS Health At CVS Health, we're dedicated to building a world of health around every consumer, driven by a passion for transforming healthcare. As the nation's leading health solutions company, we touch millions of lives through our local presence, digital channels, and a team of over 300,000 purpose-driven colleagues. Our mission is to care for people where, when, and how they choose, with a unique blend of connection, convenience, and compassion. Every day, we strive to make a difference with heart. About This Opportunity We're seeking a highly skilled and motivated Clinical Pharmacy Support Technician to join our team remotely from anywhere in the United States. As a key member of our Clinical Pharmacy Support area, you will play a crucial role in supporting the operations of our Retro DUR (Drug Utilization Review)/Scorable Action Items (SAI) Clinical Pharmacy staff. This is a unique opportunity to work from home and be part of a dynamic team that's shaping the future of healthcare. Key Responsibilities Provide operational support to clinical pharmacy staff, including outreach calls and faxes to providers, pharmacists, case managers, and members. Manage day-to-day processes, analyze data, and document relevant interactions. Support the Formulary Alternative Outreach Program for Medicare Part D, ensuring members receive the appropriate therapy as approved by providers. Initiate education for providers and pharmacies on medication options, enhancements, and alternative therapy options for members. Communicate with pharmacies to verify claim information and reverse unnecessary claims. Review overutilization data and make prescriber and/or pharmacy outreach, including reviewing formulary vs. non-formulary prescription clinical/pharmacy protocol. Ensure member is receiving the appropriate therapy as approved by the provider and determine length of therapy and establish if current claims are appropriate. Educate providers and pharmacies on formulary vs. non-formulary medications and options for alternative therapies for members. Educate Case Managers on opportunities to enhance medication utilization of members. Review therapeutic duplication data and contact providers and pharmacies to establish correct therapy for member and reverse any unnecessary RX claims while working with pharmacist. Work with team Pharmacist to investigate specific cases of overutilization, including potential member outreach to ensure member has received products that have been dispensed under plan. Maintain expert knowledge in most areas of pharmacy operations. Analyze and interpret various types of complex claim data under member plans. Work with Pharmacy to verify claims information and reverse unnecessary claims. Identify opportunities for improvement in departmental and pharmacy operations with recommendations for modes of resolution. Train, coach, and mentor new Clinical Support Technician Staff. Requirements Essential Qualifications: 4 or more years of relevant experience in a pharmacy or healthcare setting. Valid Pharmacy Technician Certification (PTCB or ExCPT). Working knowledge of Microsoft Outlook and Teams. Ability to interpret Pharmacy Claims data. Proficiency in computerized pharmacy systems and software applications. Previous provider/pharmacy outreach experience. Ability to perform duties with minimal supervision. Proficient knowledge of Brand/Generic drug names. Preferred Qualifications: Managed Care experience. Advanced knowledge of Microsoft Excel and Microsoft Access. Understanding of medical and pharmacy terminology. What We Offer Compensation and Benefits: We offer a competitive salary range of $18.50 - $35.29 per hour, depending on experience and qualifications. In addition to our base pay, this position is eligible for a CVS Health bonus, commission, or short-term incentive program. Our comprehensive benefits package includes: Affordable medical plan options. 401(k) plan with matching company contributions. Employee stock purchase plan. No-cost programs for wellness screenings, tobacco cessation, and weight management. Confidential counseling and financial coaching. Paid time off and flexible work schedules. Family leave and dependent care resources. Colleague assistance programs and tuition assistance. Retiree medical access and many other benefits depending on eligibility. Work Environment and Culture: At CVS Health, we're committed to fostering a workplace where every colleague feels valued and that they belong. Our teams reflect the customers, patients, members, and communities we serve. We prioritize the physical, emotional, and financial wellness of our colleagues and their families. As a remote worker, you'll enjoy the flexibility of working from home with a Monday - Friday schedule from 8:00 a.m. to 5:00 p.m. local time. Why Join Us? By joining our team, you'll be part of a dynamic and purpose-driven organization that's shaping the future of healthcare. You'll have opportunities for growth and development, a comprehensive benefits package, and a flexible work environment. Our colleagues are self-disciplined, hardworking, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, live for opportunities to collaborate and make a difference, and help make CVS Health the #1 Top Workplace in the area. How to Apply If you're passionate about transforming healthcare and have the skills and experience we're looking for, we encourage you to apply for this exciting opportunity. Please submit your application by July 7, 2025. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. Don't miss this chance to join our team and make a difference in the lives of millions of Americans. Apply now and start your journey with CVS Health! Apply for this job