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.

　　Position Summary

　　The Sr Rep, Clinical Services will work a rotating schedule which includes weekends and will support prior auth & appeal's Tech I, II, and III's with complex, non-clinical or prior authorization questions. Rotation will consist of various tasks to include but limited to supporting senior calls, production as needed, mailboxes, support chats, SalesForce and other tasks as assigned by leadership. The Sr Rep, Clinical Services will support supervisors with day-to-day strategic issues, handling escalated calls, training, coaching and other miscellaneous tasks based on business needs.

　　The Sr Rep, Clinical Services will promote a positive working environment and initiate suggestions to continually improve processes and protocols. Will assist supervisors with standardization of procedures, coaching, training, and dissemination of information to staff. Act as a subject matter expert in processes and procedures. Communicate clearly and accurately when interacting with all levels of employees, plan participants, physician offices and support partners.

　　Manage and support escalated, and advanced prior authorization issues as needed. Answer complex questions and recommend corrective action solutions to address complaints/concerns. Assist with inbound or outbound calls to ensure that current business needs are met. Handle special projects and assignments as designated by leadership.

　　Responsibilities

　　% Time*

　　Assists and/or mentors' colleagues with issues around PA, appeals and exceptions issues. Acts as a SME supporting various roles.

　　25%

　　Diffuses issues and complaints by physicians and members and solves escalated appeals/exceptions problems while maintaining a calm and professional attitude in emotionally charged interactions.

　　10%

　　Acts as a subject matter expert in processes and procedures within prior auth. Works closely with internal partners to develop work instructions and process improvements.

　　25%

　　Works collaboratively with internal business partners, including the RPh team and account teams, to provide solutions for customers.

　　10%

　　Responds to customer satisfaction expectations through regular and consistent attendance, scheduling flexibility and availability. Ability to exercise high discretion on sensitive and confidential matters.

　　10%

　　Demonstrates strong analytical skills with the ability to evaluate, develop, and deliver alternative courses of action.

　　10%

　　Ability to positively deal with changes in a complex and rapidly changing environment and promote a positive work environment. Assists supervisors with day to day strategic workflow and production issues and handles special projects and assignments as designated

　　by management.

　　10%

　　Required Qualifications

　　Able to apply strong computer skills. Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.

　　Must have ability to quickly learn new computer applications. Must have foundation of adjudication platforms and processes. Must be able to create and maintain reports and data collection.

　　Must be able to multitask and utilize multiple system applications simultaneously.

　　Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.

　　Must be able to utilize available resources independently and provide high quality work.

　　Must be able to absorb presented information, display motivation, seek development and problem solve.

　　Ability to adapt and change with workflow and shifting priorities.

　　Must possess excellent written, verbal, grammar, and listening communication skills.

　　Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.

　　Ability to maintain confidentiality of PHI (Protected Healthcare Information).

　　Seeks ways to collaborate and reach consensus with peers; actively works to build strong working relationships; Able to customize messages and deliver to broader audiences; Demonstrates troubleshooting, problem-solving ability, and attention to detail.

　　Demonstrates sense of urgency with assignments.

　　Demonstrates leadership skills and professional maturity. Creates a cohesive team atmosphere. Embraces change positively.

　　1. Regular and predictable attendance

　　2. Colleague will be required to work mandatory overtime/extended work week when needed

　　3. Colleague will be required to travel when needed

　　4. Assists and/or mentors' colleagues with issues around PA, appeal and exceptions issues. Acts as a SME supporting various roles

　　5. Diffuses issues and complaints by physicians and members and solves escalated appeals/exceptions problems while maintaining a calm and professional attitude in emotionally charged interactions.

　　6. Acts as a subject matter expert in processes and procedures with Prior Auth. Works closely with internal partners to develop work instructions and process improvements.

　　8. Works collaboratively with internal business partners, including the pharmacist team and account teams, to provide solutions for customers.

　　9. Responds to customer satisfaction expectations through regular and consistent attendance, scheduling flexibility and availability. Ability to exercise high discretion on sensitive and confidential matters.

　　10. Demonstrates strong analytical skills with the ability to evaluate, develop, and deliver alternative courses of action.

　　11. Ability to positively deal with changes in a complex and rapidly changing environment and promote a positive work environment. Assists supervisors with day to day tactical and production issues and handles special projects and

　　assignments as designated by leadership.

　　Preferred Qualifications

　　• Well-rounded knowledge in Specialty PA

　　• Trained in multiple tech areas

　　• At least 6 months of tenure in CRU

　　• FTE Only (contingents are not eligible to apply)

　　• Tech II's and Tech III's preferred but not required!

　　• License Preferred (not required)

　　• 3 - 5 years of related work experience.

　　Education

　　H.S or Equivalent - Required

　　Associate Degree or bachelor's degree: If neither degree held, then equivalent years of work experience. - Preferred

　　Pay Range

　　The typical pay range for this role is:

　　$18.50 - $34.60

　　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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

　　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

　　CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

　　CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.