Clinical Pharmacist
3 weeks ago
CVS Health is seeking a highly skilled Clinical Pharmacist to join our team as a Prior Authorization Specialist. 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. Your expertise will be essential in verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and utilizing clinical knowledge and resources while complying with department protocols.
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, answer clinical questions, and collect appropriate clinical/medical data
- 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, 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
- Experience using MS Office and other Windows-based computer applications
- Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information
- 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
- Ability to consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested
What We Offer
- 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
- Remote work opportunity, open to qualified candidates within the United States
- Opportunity to work with a Fortune 6 company and contribute to the transformation of our culture and acceleration of our ability to innovate and deliver solutions to make healthcare more personal, convenient, and affordable
How to Apply
Qualified applicants should submit their application through our website. We look forward to reviewing your application and discussing this opportunity further.
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