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 handle referrals, address clinical inquiries, and gather clinical/medical information.

• Assess and analyze prior authorization requests, making coverage decisions based on clinical criteria and plan specifications.

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

• Consult with physicians and healthcare providers utilizing clinical expertise and resources, adhering to departmental protocols.

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

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

• Establish and uphold communication among CVS Caremark, health plan, and employer group personnel.

• Maintain a professional and technical understanding of drug and disease states related to Specialty and Non-Specialty Pharmacy programs.

• Participate in training sessions and development meetings.

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

• Carry out other related projects and responsibilities as assigned.

⛳️ Requirements

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

• Current experience in handling commercial Prior Authorizations within Caremark PBM.

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

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

• Exceptional organizational skills and a strong attention to detail.

• Proficient in Microsoft Office applications.

• Excellent verbal and written communication as well as interpersonal skills.

• Capability to work independently and make informed clinical decisions.

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

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

• Active pharmacist license in good standing within 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 roles.

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

• Preferred: Ability to consult with pharmacy technicians and/or physicians regarding medications and formulary options.

🏝️ 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 that promote physical, emotional, and financial well-being.