Remote Clinical Pharmacist — Prior Authorization Expert

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

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