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Pharmaceutical Care Consultant

2 months ago

Tallahassee, United States CVS Health Full time

Join CVS Health in our mission to enhance health care delivery with a personal touch. Our commitment to providing human-centric health care is at the core of everything we do. We believe that how we deliver our services is just as important as the services themselves.

Position Overview

We are seeking a Clinical Pharmacist to become a vital part of our Commercial Appeals Team. In this role, you will:

  • Assess and analyze all appeals requests, collaborating with Medical Affairs to make informed coverage decisions based on clinical guidelines and medical necessity.
  • Verify insurance coverage and eligibility while interpreting clinical criteria.
  • Engage with healthcare providers to ensure timely communication of case decisions, adhering to established approval and denial management processes.

Key Responsibilities

  • Work closely with Technicians and Appeals team members to manage referrals, addressing clinical inquiries and gathering necessary medical data for assessments.
  • Handle inbound and outbound communications with various stakeholders, including healthcare providers and patients, to facilitate prior authorization requests and resolve issues.
  • Maintain up-to-date knowledge of drug therapies and disease states relevant to both Specialty and Non-Specialty Pharmacy programs.
  • Participate in additional projects and responsibilities as assigned, including training sessions and on-call availability.

Benefits

We offer a comprehensive benefits package that includes:

  • Paid time off and holidays
  • Health, dental, and vision insurance
  • 401(k) plan with company match
  • Tuition reimbursement
  • Employee discounts at CVS stores

Qualifications

To be considered for this role, candidates should possess:

  • A minimum of 2 years of experience as a clinical pharmacist in a pharmacy benefit management setting.
  • Current experience within a Commercial Appeals team.
  • Proficiency in utilizing clinical resources such as Micromedex and Lexicomp.
  • Strong organizational skills and attention to detail.
  • Excellent communication abilities, both verbal and written.
  • An active pharmacist license in good standing.

Preferred Qualifications

Additional qualifications that would be beneficial include:

  • Completion of PGY1 or PGY2 residency programs.
  • Experience in prior authorization and clinical settings.
  • Ability to consult on medication use and formulary alternatives.

At CVS Health, we are dedicated to fostering an inclusive environment where all employees feel valued and empowered. We are an equal opportunity employer, committed to diversity and inclusion in the workplace.