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CVS Caremark.

Case Manager II

CVS Caremark. - Louisville, KY

Case Manager II

Job Description


Case Manager II

No. of Positions


Position Summary

RxCrossroads Specialty Solutions

Position Summary: Do you love helping people? In this dynamic role as a Case Manager, you will serve as a liaison between the patient and the pharmacy. You will monitor processing of cases for patients with specialty pharmacy vendors and home health agencies to overcome delay in turnaround times and other obstacles. You will be in regular contact with vendors. Occasionally, you will contact physician offices, payers, specialty pharmacies, and pharmaceutical company representatives. You will receive inbound calls and make outbound calls as this position is in a call center environment.

To monitor processing of cases for patients with specialty pharmacy vendors and home health agencies to overcome delay in turnaround times and other obstacles. The Case Manager I will be in regular contact with vendors. Occasionally, the Case Manager will contact physician offices, payers, specialty pharmacies, and pharmaceutical company representatives

Req ID


Sourcing Requisition




Business Area

CVS Health

Location - State/City

KY - Louisville

Job Category

Call Center, Customer Service, Omnicare, RxCrossroads



Preferred Qualifications

Prefer three years of experience in reimbursement case management, preferable in the insurance and/or pharmaceutical/biotechnology industry. Proficient in all aspects of reimbursement (i.e. benefit investigation, prior authorization, pre-certification).

Skilled in verbal and written communication

Knowledge of Medical Terminology

Extensive knowledge of drug reimbursement issues and claim adjudication process

Knowledge of navigation through the claim denial process.

Knowledge of HCPCS, CPT and ICD-9 coding

Ability to express ideas clearly both written and oral communications

Ability to enter data correctly

Strong attention to detail and ability to handle multiple tasks well

Strong computer skills required; preferably Microsoft Word or Excel software applications

Data entry skills required

Ability to resolve problems independently

Ability to calculate figures and amounts such as discounts and percentages

Ability to carry out instructions furnished in written, oral or diagram form

Adaptable to changing priorities as needed

Have exceptional attention to detail and excellent analytical, investigation, and problem solving skills

Ability to manage multiple priorities concurrently

Responsible for meeting quality and turn-around-time objectives

Strong customer service skills; including ability to convey compassion for patients

A designation as a Certified Case Manager or licensed practical nurse or social worker is also preferred


United States

Job Type (Expected Hours Category)

Full Time

Street Address

1901 Eastpoint Parkway

Location code


Requisition Template



High School Diploma or Equivalent


Non Exempt

Clinical Licensure Required


Zip Code


Required Qualifications

Monitors drug shipments and patient training between patients, physician offices and specialty pharmacies Work with vendor contacts (specialty pharmacies and/or Home Health agencies) to expedite approval and delivery of medication and injection administration and/or injection teach

Understand reason for denial and take appropriate actions to resolve case

Re-triage cases to appropriate specialty pharmacy when/if appropriate in a timely manner

Respond to vendor statuses (written, electronic or verbal) making appropriate entries into NG system

Set follow up alarms as appropriate to resolve patient prescription request

Communicate with Case Managers II (CMII), Case Managers III (CMIII), and to work with medical practices, sales representatives regarding the status of cases

Provide consultative services where issues arise on how obstacles can be overcome in order to get patient on paid therapy

Works with CMII and CMIII to obtain missing information

Develops and works daily report and maintains e-mail of pending cases in a timely fashion

Coordinates and schedules conference calls with vendor contact and/or home health company to review status of cases

Maintains all patient confidentiality

Other duties and responsibilities as assigned by supervisor .

Business Overview

CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units - MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW


Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:


Job Reference #:


8 days 22 hours ago

CVS Caremark.

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Location: Louisville, KY

Company Profile:
CVS Caremark (NYSE: CVS), headquartered in Woonsocket, RI, is the largest pharmacy health care provider in the United States with integrated offerings across the entire spectrum of pharmacy care. Through our unique suite of assets, we are reinventing pharmacy to offer innovative solutions that help people on their path to better health. We are focused on enhancing access to care, lowering overall health care costs for plan members and payors, and improving health outcomes.