Clinical Pharmacist - Commercial Prior Authorization

The Clinical Pharmacist will collaborate with technicians and team members to process referrals, answer clinical questions, and collect necessary data for clinical assessments and reviews within service level agreements. They will evaluate prior authorization requests, render coverage determinations based on clinical criteria, verify insurance, interpret guidelines, and consult with healthcare providers. Responsibilities include promptly communicating decisions to all relevant parties, handling inbound and outbound calls to facilitate requests and resolve escalations, and maintaining communication with CVS Caremark, health plan, and employer group staff. The role also involves staying current with drug and disease state knowledge for specialty and non-specialty pharmacy programs and performing other assigned duties, including training and potential on-call availability.