Senior Medicaid Pharmacy Specialist (Clinical)

CVS Health; Phoenix (AZ); On-site; USD 25,000 - 48,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Bonus / incentive program

Job summary

CVS Health is hiring for a full-time position supporting Medicaid and/or Medicare pharmacy services. The role involves intake and processing of pharmacy authorization requests, clinical determinations, and documentation in line with CMS and company policies.

This position requires a High School diploma or GED, National Pharmacy Technician certification and state license, plus proficiency with pharmacy software and Windows-based tools. Strong communication and confidentiality are essential.

Qualifications

• National Pharmacy Technician certification and Home State License (required).
• Proficiency in computerized pharmacy systems and software applications.
• Excellent verbal and written communication skills.
• Experience with Windows-based software applications.
• Utilizes various proprietary systems to build, research, process and enter requests.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Responsibilities

• Supports coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests.
• Promotes and supports quality effectiveness of healthcare and Pharmacy Services.
• Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines.
• Determines appropriateness for medications and communicates decisions to physicians and staff.
• Performs non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate documentation meeting regulatory and accreditation requirements.
• Process requests in compliance with CMS regulations and company policies.

Skills

Verbal and written communication

Pharmacy systems familiarity

Windows-based software

Confidentiality adherence

Education

High School diploma or GED

Tools

Pharmacy software systems

Windows-based software

Job description

CVS Health is hiring for a full-time position supporting Medicaid and/or Medicare pharmacy services. The role involves intake and processing of pharmacy authorization requests, clinical determinations, and documentation in line with CMS and company policies.

This position requires a High School diploma or GED, National Pharmacy Technician certification and state license, plus proficiency with pharmacy software and Windows-based tools. Strong communication and confidentiality are essential.