Clinical Pharmacist – Prior Authorization

Job not on LinkedIn

🔥 8 minutes ago

🇺🇸 United States – Remote

💵 $45 - $76 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Collaborate with technicians and prior authorization team members to process referrals • Answer clinical questions and collect clinical/medical data for clinical assessments and reviews • Evaluate and review prior authorization requests and render coverage determinations based on clinical criteria and plan design • Verify insurance coverage and eligibility • Interpret clinical guideline criteria and consult physicians and other healthcare providers • Apply clinical knowledge and resources while complying with department protocols • Convey case decisions promptly to healthcare providers, health plans/employers, patients, and other healthcare professionals • Perform inbound and outbound calls to facilitate prior authorization requests, answer inquiries, and resolve escalations • Maintain communication among CVS Caremark, health plan, and employer group staff • Maintain professional and technical knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs • Complete related projects and duties, attend training and development meetings, and provide on-call and after-hours pharmacist availability as needed

🎯 Requirements

• Active, unrestricted pharmacist licensure • Current pharmacist experience within Caremark PA Ops required • Ability and willingness to work a flexible hourly schedule, including overtime, weekends, and holidays as needed • Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, and Visio preferable • Keyboard skills essential • Ability to multitask and utilize multiple system applications simultaneously • Ability to utilize available resources independently and provide high quality work • Problem-solving ability and attention to detail • Ability to adapt and change with workflow and shifting priorities • Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the prior authorization team • Excellent written, verbal, grammar, and listening communication skills • Ability to effectively communicate with a diverse customer base in a friendly and confident manner • Ability to maintain confidentiality of PHI • BS in Pharmacy or Pharm D • Qualified applicants 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 pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility