Clinical Pharmacist – Prior Authorization

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

📋 Description

• Collaborate with technicians and members of the prior authorization team to facilitate the processing of referrals.

• Address clinical inquiries and gather clinical/medical data for assessments and reviews.

• Assess and analyze prior authorization requests.

• Make coverage determinations based on clinical criteria and the design of the plan.

• Confirm insurance coverage and eligibility.

• Interpret criteria from clinical guidelines.

• Consult with physicians and other healthcare providers.

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

• Conduct inbound and outbound calls to support prior authorization requests, address inquiries, and manage escalations.

• Foster and uphold communication between CVS Caremark, health plan, and employer group personnel.

• Maintain professional and technical acumen regarding drug and disease states for Specialty and Non-Specialty Pharmacy programs.

• Execute related projects and tasks, participate in training and development meetings, and provide on-call and after-hours pharmacist support as needed.

⛳️ Requirements

• Must possess an active, unrestricted pharmacist license.

• Previous pharmacist experience within Caremark PA Ops is mandatory.

• Willingness and ability to work a flexible schedule, including overtime, weekends, and holidays as necessary.

• Proficiency in Microsoft Office Suite: Excel and Word are required; knowledge of Access, Outlook, PowerPoint, and Visio is preferred.

• Strong keyboarding skills.

• Capability to multitask and utilize various system applications concurrently.

• Ability to independently leverage available resources and deliver high-quality work.

• Strong problem-solving skills and attention to detail.

• Adaptability to workflow changes and shifting priorities.

• Effective teamwork skills and ability to mentor non-clinical staff within the prior authorization team.

• Excellent written, verbal, grammar, and listening communication abilities.

• Proficient in communicating with a diverse customer base in a friendly and confident manner.

• Ability to maintain confidentiality of Protected Health Information (PHI).

• Bachelor of Science in Pharmacy or Pharm D is required.

• Must reside within the United States.

🏝️ Benefits

• Comprehensive medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Options for retirement savings.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.

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