Clinical Pharmacist – Prior Authorization

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

📋 Description

• Works in collaboration with technicians and members of the prior authorization team to manage referrals.

• Assesses and reviews all prior authorization requests, making coverage determinations based on clinical criteria and plan specifications.

• Ensures that decisions regarding cases are communicated promptly and effectively.

• Engages in inbound and outbound phone communications with technicians, prior authorization team members, physicians, healthcare providers, and/or patients.

• Establishes and nurtures communication channels among CVS Caremark, health plan, and employer group personnel.

• Keeps up-to-date with professional and technical knowledge of drugs and disease states.

• Performs other related projects and responsibilities as assigned.

⛳️ Requirements

• Must possess an active, unrestricted pharmacist license.

• Previous experience as a pharmacist within Caremark PA Ops is required.

• Must be willing and able to work a flexible schedule, including overtime, weekends, and holidays as necessary.

• Proficiency in Microsoft Office Suite, specifically Excel and Word, is required; familiarity with Access, Outlook, PowerPoint, and Visio is preferred.

• Essential keyboard skills are required.

• Ability to multitask and utilize multiple system applications simultaneously is necessary.

• Must be able to leverage available resources independently and deliver high-quality work.

• Strong problem-solving skills and attention to detail are essential.

• Ability to adapt to changing workflows and shifting priorities is important.

• Capable of working effectively in a team setting and providing mentorship to non-clinical staff on the prior authorization team.

• Excellent written, verbal, grammar, and listening communication skills are required.

• Must be able to communicate effectively with a diverse customer base (both internal and external) in a friendly and confident manner.

• Ability to maintain the confidentiality of PHI (Protected Healthcare Information) is essential.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.