Clinical Pharmacist

4 weeks ago

Montpelier, Vermont, United States CVS Health Full time
Clinical Pharmacist - Prior Authorization Specialist

**Job Summary**

We are seeking a highly skilled Clinical Pharmacist to join our Prior Authorization team at CVS Health. As a Clinical Pharmacist - Prior Authorization Specialist, you will play a critical role in evaluating and reviewing prior authorization requests, rendering coverage determinations based on clinical criteria and plan design. Your expertise will be essential in ensuring that our patients receive the best possible care.

**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, and consult with physicians and other healthcare providers
* Utilize clinical knowledge and resources while complying with department protocols
* Collaborate with technicians and prior authorization team members to process referrals and answer clinical questions
* 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 and answer inquiries

**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, 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

**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) retirement savings plan and employee stock purchase plan
* Paid time off, including vacation and holidays
* Professional development opportunities and tuition reimbursement

**About CVS Health**

CVS Health is a Fortune 6 company dedicated to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose is to bring our heart to every moment of your health, and we are committed to making healthcare more personal, convenient, and affordable.

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