Clinical Pharmacist - Prior Authorization
7505 Caremark, L.L.C.We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
Ready to take your Clinical Pharmacist skills to the next level with a Fortune 6 company? Check out this outstanding opportunity for a Clinical Pharmacist with CVS Health.
This position is for a Clinical Pharmacist working in the Prior Authorization team.
- Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements.
- Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
- One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes.
- Performs and handles 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.
- Establishes and maintains communication among CVS Caremark, health plan, and employer group staff.
- Maintains 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.
- Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.
Required Qualifications
-Active pharmacist license in the state of residence that is in good standing
-Current experience as clinical Pharmacist within Caremark PA team
-Demonstrated ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft office applications)
-Ability to type 30 WPM or greater
-Demonstrated pharmacist experience within PBM environment, including prior authorization experience
-Excellent oral and written communication skills
-Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment
-Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome
-Must be able to work independently and utilize critical thinking/problem solving skills to make case decisions
-Receptive to constructive feedback and flexible in adapting to change
-Flexibility with working a rotating schedule including overtime, weekends, and holidays.
Education
BS in Pharmacy or PharmD
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$55.53 - $93.08This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.