Transforming Healthcare with CVS Health: Join Our Team as a Clinical Pharmacist - Prior Authorization Specialist
At CVS Health, we're driven by a singular purpose: to bring our heart to every moment of your health. As a leading healthcare company, we're committed to delivering enhanced, human-centric health care that's both personal and convenient. Our Heart At Work Behaviors guide our actions, empowering every team member to play a vital role in transforming our culture and accelerating innovation.
We're now seeking an experienced Clinical Pharmacist to join our Prior Authorization team as a Prior Authorization Specialist. This remote role offers the opportunity to leverage your clinical expertise, make a meaningful impact on patient care, and grow with a Fortune 6 company.
About the Role: Clinical Pharmacist - Prior Authorization Specialist
As a Clinical Pharmacist - Prior Authorization Specialist, you'll collaborate with our technicians and prior authorization team members to process referrals, answer clinical questions, and collect relevant clinical data. Your expertise will be crucial in evaluating and reviewing prior authorization requests, rendering coverage determinations based on clinical criteria and plan design, and communicating decisions to healthcare providers, health plans, employers, patients, and other stakeholders.
Key Responsibilities:
- Collaborate with technicians and prior authorization team members to process referrals, answer clinical questions, and collect clinical/medical data needed for clinical assessments and reviews.
- Evaluate and review prior authorization requests, verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and utilizing clinical knowledge and resources to make informed decisions.
- Communicate coverage determinations promptly and efficiently to healthcare providers, health plans/employers, patients, and other stakeholders, following agreed-upon approval and denial management processes.
- Handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and patients to facilitate prior authorization requests, answer inquiries, and resolve escalations.
- Establish and maintain effective communication among CVS Caremark, health plan, and employer group staff.
- Stay up-to-date with professional and technical knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs.
- Perform 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.
Essential Qualifications:
- 2+ years of experience working as a pharmacist in a PBM setting.
- Current experience working with commercial Prior Authorizations in PBM.
- Experience using clinical resources such as Micromedex, Lexicomp, and Clinical Pharmacology.
- Ability to prioritize, quickly assess, and manage multiple tasks, adapting to constantly changing situations.
- Excellent organizational skills, with strong detail orientation.
- Strong Microsoft Office skills, with excellent oral and written communication and interpersonal skills.
- Ability to work independently, making 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 in good standing in the state of residence.
Preferred Qualifications:
- PGY1/PGY2 residency training.
- Prior authorization, call center, and clinical experience.
- Exposure to clinical and analytical problem-solving.
- Ability to consult with pharmacy technicians and/or physicians regarding medication use and advise on appropriate formulary alternatives.
Education:
Bachelor's of Science - Pharmacy or Pharm.D.
What We Offer:
At CVS Health, we provide a comprehensive benefits package, including:
- Competitive salary ($38.63 - $83.17 per hour).
- Bonus, commission, or short-term incentive programs.
- Medical, dental, and vision benefits.
- Employee discounted stock purchase program.
- 401K retirement savings plan.
- Tuition reimbursement.
- 20-30% employee discount at all CVS stores.
- Paid Time Off (PTO) or vacation pay.
- Paid holidays throughout the calendar year.
- Well-being programs, education assistance, free development courses, and discount programs with participating partners.
Career Growth and Development:
As a Clinical Pharmacist - Prior Authorization Specialist, you'll have opportunities to grow and develop your skills, advancing your career within CVS Health. Our company culture encourages innovation, collaboration, and continuous learning, ensuring you stay at the forefront of healthcare excellence.
Our Work Environment:
This is a remote role, offering the flexibility to work from anywhere within the United States. We're committed to creating a work environment that's inclusive, supportive, and empowering, allowing you to thrive and make a meaningful impact.
Join Our Team:
If you're a dedicated Clinical Pharmacist looking for a challenging and rewarding opportunity, we want to hear from you. Apply now to join our team as a Clinical Pharmacist - Prior Authorization Specialist and help transform healthcare with CVS Health.
Don't miss this chance to make a difference in patient care and grow with a leading healthcare company. Apply today!
Apply Now