RPh Operations Advisor – Medical Prior Authorizations

CVS Health

Clinical Pharmacist reviewing specialty-medication prior authorizations for CVS Health’s Aetna operations. Applying clinical criteria, issuing determinations, handling calls, and mentoring PA representatives remotely from Florida.

Posted 8/18/2026full-timeRemote • Florida • 🇺🇸 United StatesJuniorMid-Level💰 $50 - $85 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical pharmacy with a focus on prior authorization processes, including issuing clinical determinations and utilizing systems like Novologix. Strong communication and interpersonal skills are essential for effective collaboration with healthcare professionals and team members.

Highest-signal resume keywords

Active Pharmacist LicenseClinical Pharmacist ExperiencePrior Authorization ExperienceNovologix System ProficiencyMicrosoft Office Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical DeterminationsPrior Authorization ProceduresPharmacy OperationsAttention to DetailProblem-Solving

Soft Skills

Interpersonal SkillsTeam CollaborationCommunication SkillsAdaptabilityUrgency in Prioritization

Tools & Technologies

NovologixCASSales ForceRxClaimPeopleSafe

Certifications & Qualifications

Bachelor of PharmacyPharmD

Industry Keywords

Prior AuthorizationClinical PharmacyCall Center ExperiencePBM ExperienceHealthcare Professionals

About the role

Key responsibilities & impact

Conduct reviews of medical data to perform prior authorization review for specialty medications
Apply clinical knowledge and approved criteria to prospective and concurrent case reviews
Use CVS Caremark-supported systems to process prior authorizations
Take inbound calls from physicians or members regarding pending, approved, or denied prior authorizations
Work operational hours of 8am–7pm CT
Work rotating weekends and occasional holidays as required by business needs
Issue clinical determinations within Aetna Medical Prior Authorization Operations
Follow prior authorization procedures to ensure timely and accurate processing
Train and mentor representatives on the prior authorization team
Communicate with pharmacists, clinical colleagues, healthcare professionals, and members
Prioritize calls and assignments with a high level of urgency

Requirements

What you’ll need

Active pharmacist license in state of residence in good standing
2+ years of clinical pharmacist experience
1+ years of demonstrated experience issuing clinical determinations within Prior Authorizations
Current experience working within the Novologix system, specifically Aetna Medical Prior Authorization Operations
Current experience issuing clinical determinations within Aetna Medical Prior Authorization
Excellent interpersonal skills
Problem-solving ability and attention to detail
Ability to work effectively in a team environment with dependability
Excellent oral and written communication skills
Ability to quickly assess and adapt to changing situations
High mental agility and alertness
Ability to communicate effectively with pharmacists, clinical colleagues, healthcare professionals, and members
Ability to effectively prioritize work while exhibiting urgency with calls and assignments
Ability to train and mentor representatives on the PA team
Call center, PBM, or clinical experience
Strong Microsoft Office skills
Experience utilizing CAS, Novologix, Sales Force, RxClaim, and PeopleSafe
Bachelor of Pharmacy or PharmD
Ability to work 8am–7pm CT
Ability to work rotating weekends and occasional holidays as required

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being