Clinical Pharmacist
2 days ago
At CVS Health, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose guides our commitment to innovation and excellence in everything we do.
Job SummaryWe're seeking a highly skilled Clinical Pharmacist to join our Commercial Appeals Team. As a key member of our team, you'll play a critical role in evaluating and reviewing appeals requests, working closely with Medical Affairs to render coverage determinations based on clinical criteria and plan design.
Key Responsibilities- Evaluate and review appeals requests, ensuring timely and efficient decision-making
- Collaborate with Medical Affairs to render coverage determinations based on clinical criteria and plan design
- Verify insurance coverage and eligibility, interpreting clinical guideline criteria and consulting with physicians and other healthcare providers
- Utilize clinical knowledge and resources to make informed decisions, while complying with department protocols
- Communicate decisions promptly and efficiently to healthcare providers, health plans/employers, patients, and other healthcare professionals
- 2+ years' experience working as a clinical pharmacist in a PBM setting
- Current experience working with the Caremark Commercial Appeals team
- Experience using clinical resources, such as Micromedex and Lexicomp
- Ability to prioritize, quickly assess, and manage multiple tasks and adapt to changing situations
- Excellent organizational skills, strong detail orientation, and excellent oral and written communication skills
We offer 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. This is a remote role open to candidates within the United States.
Why Join CVS Health?At CVS Health, we're committed to making a positive impact on the lives of our patients, customers, and colleagues. We offer a dynamic and supportive work environment, with opportunities for growth and development. Join our team and be part of something bigger than yourself.
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