Clinical Pharmacist – Prior Authorization

This is a fully remote position, open to applicants in Florida.

📋 Description

• Collaborate with technicians and members of the prior authorization team to process referrals, address clinical inquiries, and gather clinical/medical data for assessments and reviews.

• Assess and review prior authorization requests, making coverage determinations based on clinical criteria and plan design.

• Confirm insurance coverage and eligibility while interpreting clinical guideline criteria.

• Consult with physicians and other healthcare providers, applying clinical knowledge and departmental protocols.

• Communicate case decisions promptly to healthcare providers, health plans/employers, patients, and other healthcare professionals.

• Manage inbound and outbound calls to facilitate prior authorization requests, respond to inquiries, and resolve escalations.

• Foster and maintain communication among CVS Caremark, health plan, and employer group staff.

• Keep up-to-date with professional and technical knowledge of drug and disease states for both Specialty and Non-Specialty Pharmacy programs.

• Participate in training sessions and development meetings.

• Provide on-call and after-hours pharmacist availability as needed.

• Carry out other related projects and duties as assigned.

⛳️ Requirements

• Minimum of 2 years of experience as a pharmacist in a PBM environment.

• Current experience with commercial Prior Authorizations within Caremark PBM.

• Familiarity with clinical resources such as Micromedex, Lexicomp, and Clinical Pharmacology.

• Capability to prioritize, assess quickly, manage multiple tasks, and adapt to rapidly changing situations.

• Exceptional organizational skills and strong attention to detail.

• Proficient in Microsoft Office applications.

• Excellent verbal and written communication skills, along with strong interpersonal abilities.

• Ability to work independently and make informed clinical decisions.

• Experience with MS Office and other Windows-based computer applications.

• Capacity to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.

• Active pharmacist license in good standing in the state of residence.

• Bachelor of Science in Pharmacy or Pharm.D.

• Preferred: PGY1/PGY2 residency.

• Preferred: Experience in prior authorization, call center, and clinical settings.

• Preferred: Exposure to clinical and analytical problem-solving.

• Preferred: Ability to consult with pharmacy technicians and/or physicians regarding medication use and provide advice on formulary alternatives.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to the base salary range.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting the physical, emotional, and financial well-being of colleagues and their families.