Clinical Pharmacist - Prior Authorization

CVS Health; Georgia; Hybrid; USD 63,000 - 105,000; Full time

Job summary

CVS Health is seeking a Clinical Pharmacist to join the Prior Authorization team in a remote capacity in the United States. This full-time role focuses on evaluating prior authorization requests and rendering coverage determinations based on clinical criteria and plan design.

The position requires 2+ years of PBM pharmacy experience, an active state license, and strong communication skills. Collaboration with technicians, physicians, and health plans is essential to ensure timely decisions and

Qualifications

• 2 years' pharmacist experience in a PBM setting.
• Current experience with Commercial Prior Authorizations in Caremark PBM
• Experience using clinical resources such as Micromedex and Lexicomp
• Ability to prioritize and manage multiple tasks in a dynamic environment
• Excellent organizational, written and verbal communication skills
• Active pharmacist license in the state of residence
• Ability to work independently and make clinical decisions

Responsibilities

• Process referrals with technicians and prior authorization team to collect data for assessments.
• Evaluate prior authorization requests and render coverage determinations.
• Convey decisions promptly to providers, health plans, patients and other professionals.
• Handle inbound/outbound calls to facilitate prior authorization requests and resolve escalations.
• Coordinate communication among CVS Caremark, health plans and employer groups.
• Maintain knowledge of drug/disease states for Specialty and Non-Specialty programs.
• Engage in training, development meetings and after-hours pharmacist availability.

Skills

PBM experience

Pharmacist license

Caremark PBM

Clinical reasoning

MS Office

Communication skills

Independent work

Education

Pharmacy degree

Tools

Micromedex

Lexicomp

Clinical Pharmacology

Job description

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.

Position Summary

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.

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

• 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 qualified candidates within the United States.

Required Qualifications

• 2 years' experience working as a pharmacist in a PBM setting.
• Current experience working with Commercial Prior Authorizations in Caremark PBM
• Experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology
• Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations.
• Excellent organizational skills. Strong detail orientation.
• Strong Microsoft Office skills. Excellent oral and written communication skills and interpersonal skills.
• Ability to work independently and make clinical decisions.
• Experience using MS Office and other Windows based computer applications.
• Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
• Active pharmacist license that is in good standing in the state of residence.

Preferred Qualifications

• PGY1/PGY2
• Prior authorization, call center and clinical experience.
• Exposure to clinical and analytical problem solving.
• Ability to consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.

Education

Bachelor's of Science - Pharmacy or Pharm.D

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$45.43 - $76.15

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.

We anticipate the application window for this opening will close on: 08/29/2026

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