Clinical Pharmacist – Prior Authorization

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

📋 Description

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

• Assess and review prior authorization requests, making coverage determinations guided by clinical criteria and plan specifications.

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

• Engage with physicians and other healthcare providers, applying clinical expertise and departmental protocols.

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

• Conduct inbound and outbound calls to support prior authorization requests, respond to inquiries, and handle escalations.

• Ensure ongoing communication among CVS Caremark, health plan, and employer group personnel.

• Keep up-to-date with professional and technical knowledge regarding drug and disease states relevant to Specialty and Non-Specialty Pharmacy programs.

• Participate in training sessions and development meetings.

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

• Complete additional 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 in the Caremark PBM context.

• Proven experience utilizing clinical resources such as Micromedex, Lexicomp, and Clinical Pharmacology.

• Capability to prioritize tasks, quickly assess situations, manage multiple responsibilities, and adapt to dynamically changing conditions.

• Exceptional organizational abilities and a keen attention to detail.

• Proficient in Microsoft Office applications.

• Strong oral and written communication skills as well as excellent interpersonal abilities.

• Capacity to work independently and make clinical decisions.

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

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

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

• Bachelor of Science in Pharmacy or Pharm.D.

• Preferred: Completion of PGY1/PGY2 residency.

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

• Preferred: Familiarity with clinical and analytical problem-solving.

• Preferred: Ability to consult with pharmacy technicians and/or physicians regarding medication use and to develop alternative solutions.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, subject to eligibility.