Remote Clinical Pharmacist - Prior Authorization Expert

CVS Health; United States; Remote; USD 105,000 - 176,000; Full time

Benefits offered by this job

Medical insurance

Dental & Vision coverage

Retirement savings options

Paid time off

Job summary

CVS Health is seeking a Clinical Pharmacist to join the Prior Authorization team. This remote role, open to the United States, focuses on processing referrals, evaluating requests, and communicating outcomes to providers and plans.

The position requires 2 years of PBM pharmacy experience, familiarity with Caremark PBM, and licensed pharmacist in good standing. Comprehensive benefits and ongoing professional development are offered.

Qualifications

• 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 fast-paced environment.
• Strong written and verbal communication skills.
• Active pharmacist license in good standing in state of residence.

Responsibilities

• Process referrals and collect data for clinical assessments per criteria and SLAs.
• Evaluate prior authorization requests and render coverage determinations.
• Communicate decisions promptly to providers, plans, patients and health plans.
• Handle inbound/outbound calls to facilitate prior authorizations and resolve escalations.
• Maintain communication among CVS Caremark, health plans and employer groups.
• Maintain knowledge of drug/disease states for Specialty and Non-Specialty Pharmacy programs.
• Attend training and provide on-call and after-hours pharmacist availability.

Skills

PBM experience

Prior Authorization

Clinical data collection

Clinical decision making

Communication

Education

Doctor of Pharmacy or PharmD

Bachelor of Science - Pharmacy

Tools

Micromedex

Lexicomp

Clinical Pharmacology

MS Office

Job description

CVS Health is seeking a Clinical Pharmacist to join the Prior Authorization team. This remote role, open to the United States, focuses on processing referrals, evaluating requests, and communicating outcomes to providers and plans.

The position requires 2 years of PBM pharmacy experience, familiarity with Caremark PBM, and licensed pharmacist in good standing. Comprehensive benefits and ongoing professional development are offered.