Clinical Pharmacist – Prior Authorization

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

📋 Description

• Collaborate with technicians and members of the prior authorization team to effectively process referrals.

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

• Assess and review prior authorization requests, making coverage determinations based on clinical criteria and plan design.

• Confirm insurance coverage and eligibility status.

• Interpret clinical guideline criteria, consulting with physicians and other healthcare providers as necessary.

• Utilize clinical knowledge and resources while adhering to department protocols.

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

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

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

• Keep current on professional and technical knowledge of drug and disease states for both Specialty and Non-Specialty Pharmacy programs.

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

⛳️ Requirements

• Possess an active, unrestricted pharmacist license.

• Have current pharmacist experience within Caremark PA Ops.

• Demonstrated ability and willingness to work a flexible hourly schedule, including overtime, weekends, and holidays as needed.

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

• Strong keyboard skills are essential.

• Capability to multitask and utilize multiple system applications concurrently.

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

• Strong problem-solving skills and attention to detail.

• Flexibility to adapt to workflow changes and shifting priorities.

• Effective teamwork skills and ability to provide mentorship to non-clinical staff on the prior authorization team.

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

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

• Ability to maintain the confidentiality of PHI.

• A BS in Pharmacy or Pharm D is required.

• Qualified candidates with arrest or conviction records will be considered in accordance with federal, state, and local laws.

🏝️ Benefits

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

• Medical coverage options available.

• Dental coverage provided.

• Vision coverage included.

• Paid time off is offered.

• Retirement savings options available.

• Wellness programs to support employee health.

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