Clinical Pharmacist – Prior Authorization

Job not on LinkedIn

🔥 0 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 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 guidelines, consult physicians and healthcare providers, and apply clinical knowledge while following department protocols • Communicate case decisions promptly to healthcare providers, health plans/employers, patients, and other healthcare professionals • Handle inbound and outbound calls to facilitate prior authorization requests, answer inquiries, and resolve escalations • Establish and 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 • Attend training sessions and development meetings • Provide on-call and after-hours pharmacist availability as needed • Consult with pharmacy technicians and physicians regarding medication use and recommend formulary alternatives when requested

🎯 Requirements

• 2 years’ experience working as a pharmacist in a PBM setting • Current experience working with commercial Prior Authorizations within Caremark PBM • Experience using clinical resources such as Micromedex, Lexicomp, and Clinical Pharmacology • Ability to prioritize, quickly assess, manage multiple tasks, and adapt to changing situations • Excellent organizational skills and strong detail orientation • Strong Microsoft Office skills • Excellent oral and written communication and interpersonal skills • Ability to work independently and make clinical decisions • Experience using MS Office and other Windows-based computer applications • Ability to receive calls from prior authorization pharmacy technicians and/or providers for clinical information • Active pharmacist license in good standing in the state of residence • Bachelor's of Science in Pharmacy or Pharm.D. • Preferred: PGY1/PGY2 • Preferred: Prior authorization, call center, and clinical experience • Preferred: Exposure to clinical and analytical problem solving

🏖️ 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 colleagues' physical, emotional, and financial well-being • Comprehensive benefits package for eligible full-time colleagues and their families