[Remote] Clinical Pharmacist - Prior Authorization at CVS Health

Michigan City, Mississippi, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

2 years’ experience working as a pharmacist in a PBM setting
Current experience working with commercial Prior Authorizations in Caremark PBM
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
Bachelor’s of Science - Pharmacy or Pharm.D

Responsibilities

Collaborates with technicians and prior authorization team members to process referrals, answering clinical questions and collecting clinical/medical data
Evaluate and review prior authorization requests and render coverage determinations based on clinical criteria and plan design
Verify insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers
Guarantee prompt and efficient conveyance of decisions to healthcare providers, health plans/employers, patients, and other healthcare professionals
Performs inbound and outbound phone calls to facilitate prior authorization requests, answer inquiries, and 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
Performs other related projects and duties as assigned, including attending training sessions and development meetings
Provides on-call and after-hours pharmacist availability as needed

Skills

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.

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