[Remote] Clinical Pharmacist - Prior Authorization at CVS Health

United States

Apply Now

Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, PharmacyIndustries

Requirements

2 years’ experience working as a pharmacist in a PBM setting
Current experience working within commercial Prior Authorizations in PBM (Caremark)
Experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology
Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations
Excellent organizational skills. Strong detail orientation
Strong Microsoft Office skills. Excellent oral and written communication skills and interpersonal skills
Ability to work independently and make clinical decisions
Experience using MS Office and other Windows based computer applications
Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information
Active pharmacist license that is in good standing in the state of residence

Responsibilities

Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements
Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols
Guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes
Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations
Establishes and maintains communication among CVS Caremark, health plan, and employer group staff
Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business
Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed

Skills

Key technologies and capabilities for this role

Clinical PharmacologyPrior AuthorizationPharmacy Benefit ManagementClinical Criteria ReviewInsurance VerificationPatient CommunicationHealthcare Provider ConsultationCoverage DeterminationMedical Data CollectionService Level Agreements

Questions & Answers

Common questions about this position

What benefits are offered for this Clinical Pharmacist position?

The role offers a competitive benefit package including vacation, 10 paid holidays per year, health/dental/vision insurance, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at all CVS stores.

Is this Clinical Pharmacist role remote?

Yes, this is a remote role open to candidates within the United States.

What qualifications are required for this position?

Candidates need 2 years’ experience working as a pharmacist in a PBM setting and current experience, along with skills in clinical assessments, prior authorization processing, and communication with healthcare providers.

What is the salary for this Clinical Pharmacist role?

This information is not specified in the job description.

What makes a strong candidate for this Prior Authorization Clinical Pharmacist role?

A strong candidate will have at least 2 years of pharmacist experience in a PBM setting, expertise in evaluating prior authorization requests using clinical criteria, and the ability to collaborate with team members and healthcare providers while managing phone communications.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

Land your dream remote job 3x faster with AI

Try Jobo Free