Clinical Pharmacist – Prior Authorization

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🔥 0 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $55 - $93 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Collaborates with the technicians and prior authorization team members to process referrals • Evaluate and review all prior authorization requests and render coverage determinations • Guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals • Performs and handles inbound and outbound phone calls to facilitate prior authorization requests • Establishes and maintains communication among CVS Caremark, health plan, and employer group staff • Maintains professional and technical knowledge of drug and disease states • Performs other related projects and duties as assigned

🎯 Requirements

• Active pharmacist license in the state of residence that is in good standing • Current experience as clinical Pharmacist within Caremark PA team • Demonstrated ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft office applications) • Ability to type 30 WPM or greater • Demonstrated pharmacist experience within PBM environment, including prior authorization experience • Excellent oral and written communication skills • Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment • Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome • Must be able to work independently and utilize critical thinking/problem solving skills to make case decisions • Receptive to constructive feedback and flexible in adapting to change • Flexibility with working a rotating schedule including overtime, weekends, and holidays.

🏖️ Benefits

• Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Comprehensive benefits package