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Clinical Pharmacist

2 months ago

Austin, Texas, United States CVS Health Full time
Job Summary

CVS Health is seeking a highly skilled Clinical Pharmacist to join our Prior Authorization team. As a Clinical Pharmacist, you will play a critical role in ensuring that patients receive the necessary medications and treatments to manage their health conditions.

Key Responsibilities
  • Collaborate with technicians and prior authorization team members to process referrals, including answering clinical questions and collecting relevant clinical/medical data.
  • Evaluate and review prior authorization requests, rendering coverage determinations based on clinical criteria and plan design.
  • Verify insurance coverage and eligibility, interpret clinical guideline criteria, consult with physicians and other healthcare providers, and utilize clinical knowledge and resources while complying with department protocols.
  • Communicate decisions to healthcare providers, health plans/employers, patients, and other healthcare professionals in a timely and efficient manner.
  • Perform and handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
  • Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
Requirements
  • 2 years' experience working as a pharmacist in a PBM setting.
  • Current experience working within commercial Prior Authorizations in PBM (Caremark).
  • 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, and strong Microsoft Office skills.
  • Ability to work independently and make clinical decisions.
  • Active pharmacist license that is in good standing in the state of residence.
Preferred Qualifications
  • PGY1/PGY2.
  • Prior authorization, call center, and clinical experience.
  • Exposure to clinical and analytical problem-solving.
What We Offer

CVS Health offers 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.