Clinical Pharmacist

1 week ago


Charleston, West Virginia, United States CVS Health Full time
Job Summary

CVS Health is seeking a Clinical Pharmacist to join our Prior Authorization team. As a Clinical Pharmacist, you will play a critical role in evaluating and reviewing prior authorization requests, rendering coverage determinations based on clinical criteria and plan design. You will work closely with our team to ensure that decisions are conveyed promptly and efficiently to healthcare providers, health plans/employers, patients, and other healthcare professionals.

Key Responsibilities

* Evaluate and review prior authorization requests and render 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
* Collaborate with technicians and prior authorization team members to process referrals, answer clinical questions, and collect clinical/medical data needed to perform clinical assessments and reviews
* 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

Requirements

* 2 years' experience working as a pharmacist in a PBM setting, including prior authorization experience in a PBM environment
* Demonstrated experience using clinical resources, such as Micromedex, Lexicomp, and 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

Preferred Qualifications

* PGY1/PGY2
* Prior authorization, call center, and clinical experience
* Exposure to clinical and analytical problem-solving

What We Offer

* Competitive pay range: $34.76 - $99.81
* Comprehensive benefits package, including medical, dental, and vision insurance, 401(k), and tuition reimbursement
* Opportunities for professional growth and development, including training sessions and development meetings
* Flexible work arrangements, including remote work options

About CVS Health

CVS Health is a Fortune 6 company that is dedicated to delivering enhanced human-centric health care for a rapidly changing world. We are committed to putting our heart into caring for our colleagues and our communities. If you are a motivated and detail-oriented Clinical Pharmacist looking for a challenging and rewarding role, we encourage you to apply.
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