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 manage referrals.

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

• Assess and review prior authorization requests and make 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.

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

• Handle inbound and outbound calls to support prior authorization requests, respond to inquiries, and resolve escalations.

• Maintain ongoing communication among CVS Caremark, health plan, and employer group staff.

• Stay updated on professional and technical knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs.

• Complete related projects and duties, participate in training and development meetings, and provide on-call/after-hours support as required.

⛳️ Requirements

• Current, unrestricted pharmacist licensure.

• Relevant pharmacist experience within Caremark PA Ops is mandatory.

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

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

• Essential keyboard skills.

• Ability to multitask and use multiple system applications concurrently.

• Capability to leverage available resources independently while delivering high-quality work.

• Strong problem-solving skills and attention to detail.

• Adaptability to changes in workflow and shifting priorities.

• Effective teamwork skills and the ability to mentor non-clinical staff.

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

• Proficient in communicating effectively with a diverse customer base.

• Ability to uphold the confidentiality of PHI.

• Bachelor's degree in Pharmacy or Pharm D.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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