Clinical Pharmacist – Prior Authorization

Jobtailor; Deutschland; Vor Ort; EUR 60.320 - 102.544; Vollzeit

Zusammenfassung

CVS Health is seeking a Clinical Pharmacist to join the Prior Authorization team in a remote US role. You will collaborate with technicians and clinicians to review requests and ensure compliance with plan criteria.

Requires an active pharmacist license, experience with Caremark PA Ops, and proficiency in Microsoft Office. You will handle calls, communicate decisions to providers and plans, and contribute to process improvements.

Qualifikationen

• Active, unrestricted pharmacist licensure.
• Experience in Caremark PA Ops.
• Ability to work flexible hourly schedule including overtime, weekends, holidays.
• Proficient with Microsoft Office Suite; Excel and Word required.
• Ability to multitask and use multiple systems simultaneously.
• Strong problem solving and attention to detail.
• Ability to communicate with diverse stakeholders effectively.

Aufgaben

• Process referrals with the prior authorization team and collect necessary clinical data.
• Evaluate PA requests and render coverage determinations per plan criteria.
• Convey decisions promptly to providers, plans, patients, and other professionals.
• Handle inbound/outbound calls to facilitate PA requests and resolve escalations.
• Maintain communication among CVS Caremark, health plan, and employer staff.
• Maintain knowledge of drugs and disease states for relevant programs.
• Participate in training, meetings, and after-hours on-call duties.

Kenntnisse

Licensure

Caremark PA Ops experience

Flexible schedule

Multitasking

Communication

PHI confidentiality

Team mentorship

Ausbildung

BS in Pharmacy or PharmD

Tools

Excel

Word

Outlook

PowerPoint

Visio

Jobbeschreibung

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This position is for a Clinical Pharmacist working in the Prior Authorization team.

Ready to take your Clinical Pharmacist skills to the next level with a Fortune 6 company? Check out this outstanding opportunity for a Clinical Pharmacist with CVS Health.

• Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer‑agreed criteria within the designated service level agreements.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
• One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed‑upon approval & denial management processes.
• Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
• Establishes and maintains communication among CVS Caremark, health plan, and employer group staff.
• Maintains professional and technical knowledge of drug and disease states for the Specialty and Non‑Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
• Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on‑call and after‑hours pharmacist availability as needed.

This is a remote role open to candidates within the United States.

Required Skills & Other Minimum Required Qualifications

• Active, unrestricted pharmacist licensure
• Current pharmacist experience within Caremark PA Ops required
• Ability and willingness to work a flexible hourly schedule to include overtime, weekends, and holidays as needed
• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.
• Must be able to multitask and utilize multiple system applications simultaneously.
• Must be able to utilize available resources independently and provide high quality work.
• Must demonstrate problem solving ability and attention to detail.
• Ability to adapt and change with workflow and shifting priorities.
• Ability to work effectively in a team environment and provide mentorship to non‑clinical staff on the prior authorization team.
• Must possess excellent written, verbal, grammar, and listening communication skills.
• Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner.
• Ability to maintain confidentiality of PHI (Protected Healthcare Information).

Education

BS in Pharmacy or Pharm D

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$50.48 – $84.62

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.