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Medication Management Pharmacist
2 months ago
Join CVS Health and contribute to our mission of enhancing health care with compassion and dedication. At CVS Health, we believe in the importance of delivering personalized health services that cater to the evolving needs of our communities.
Position Overview
We are seeking a Clinical Pharmacist to join our esteemed Commercial Appeals Team. In this role, you will be responsible for:
- Assessing and reviewing all Appeals requests, collaborating with Medical Affairs to make informed coverage decisions based on clinical guidelines and medical necessity.
- Verifying insurance coverage and eligibility while interpreting clinical criteria and consulting with healthcare professionals.
- Ensuring timely communication of case decisions to healthcare providers, health plans, and patients, adhering to established approval and denial processes.
Key Responsibilities
- Work closely with Technicians and Appeals team members to manage referrals, answer clinical inquiries, and gather necessary clinical data for assessments.
- Handle inbound and outbound communications with various stakeholders to facilitate prior authorization requests and resolve escalations.
- Maintain up-to-date knowledge of drug therapies and disease states relevant to our Specialty and Non-Specialty Pharmacy programs.
- Participate in additional projects and responsibilities as assigned, including training sessions and providing after-hours support as needed.
What We Offer
We provide a comprehensive benefits package that includes:
- Generous vacation and paid holidays.
- Health, dental, and vision insurance.
- Employee stock purchase program and 401K.
- Tuition reimbursement and employee discounts at CVS stores.
This position is fully remote, allowing you to work from anywhere within the United States.
Qualifications
To be considered for this role, you should possess:
- A minimum of 2 years of experience as a clinical pharmacist in a pharmacy benefit management (PBM) environment.
- Current experience on a Commercial Appeals team.
- Proficiency in using clinical resources such as Micromedex and Lexicomp.
- Strong organizational skills and attention to detail.
- Excellent communication skills, both verbal and written.
- A valid pharmacist license in good standing in your state of residence.
Preferred Qualifications
Additional qualifications that would be beneficial include:
- Completion of PGY1 or PGY2 residency programs.
- Experience in prior authorization and clinical problem-solving.
- Ability to consult with healthcare professionals regarding medication use and formulary alternatives.
Education
A Bachelor's of Science in Pharmacy or a Pharm.D. is required for this position.
At CVS Health, we are committed to fostering an inclusive environment and are proud to be an equal opportunity employer. We value diversity and do not discriminate based on any characteristic protected by law.
