Remote Clinical Pharmacist: Prior Authorization Expert

CVS Health; Austin (TX); On-site; USD 144,648,000 - 242,458,000; Full time

Job summary

CVS Health is seeking a Clinical Pharmacist for the Prior Authorization team. This remote role focuses on processing referrals, collecting clinical data, and making coverage determinations based on plan criteria.

The position requires PBM experience, strong clinical knowledge, and the ability to collaborate with technicians, physicians, and health plans. Full-time, remote within the United States.

Qualifications

• Active pharmacist license in good standing in the state of residence.
• 2 years’ experience as a pharmacist in a PBM setting.
• Experience with commercial Prior Authorizations within Caremark PBM.
• Ability to prioritize and manage multiple tasks in a dynamic environment.

Responsibilities

• Process referrals and collect clinical data for assessments per criteria and SLAs.
• Evaluate prior authorization requests and render coverage determinations based on clinical guidelines.
• Communicate approval or denial decisions promptly to providers and plans.
• Handle inbound/outbound calls with technicians, physicians, and patients to facilitate PA requests.
• Maintain knowledge of CVS Caremark programs and CRU practices.

Skills

Pharmacist license

PBM experience

Clinical data interpretation

Communication skills

Independent work

Education

Bachelor's of Science - Pharmacy or Pharm.D.

Tools

Micromedex

Lexicomp

Clinical Pharmacology

Job description

CVS Health is seeking a Clinical Pharmacist for the Prior Authorization team. This remote role focuses on processing referrals, collecting clinical data, and making coverage determinations based on plan criteria.

The position requires PBM experience, strong clinical knowledge, and the ability to collaborate with technicians, physicians, and health plans. Full-time, remote within the United States.