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.
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.
This is a remote role open to candidates within the United States.
Required Qualifications
• 2 years' experience working as a pharmacist in a PBM setting.
• Current experience working with commercial Prior Authorizations within Caremark PBM
• 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.
• Strong Microsoft Office skills. Excellent oral and written communication skills and interpersonal 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.
Education
Bachelor's of Science - Pharmacy or Pharm.D.
Job Families for Job Profiles
Worker Sub-Type
Regular
Time Type
Full time
Remote Type
Remote
Primary Location
Work At Home-Texas
Primary Job Posting Location
TX - Work from home
Scheduled Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$50.48 - $84.62
This 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.
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. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
...PR & Communications Manager Are you a sharp PR practitioner with a nose for a great B2B story and a track record of landing coverage that actually matters? Do you thrive in a fast-paced agency environment where the best idea wins and real results are the metrics that...
...This role requires the ability to work lawfully in the U.S. without employment-based immigration... ...decisions and drives innovation? Join Spectrum as an Associate Data Scientist and help... .... Eligible employees can work from home up to one day each week.How Youll Make an...
...insurance ~ Life insurance ~ Professional training reimbursement ~401K ~ Disability insurance Job Description: The Accounting Assistant must follow established policies and procedures, alert his/her supervisor if a task or process is out of compliance to...
Referrals Project Manager Define Referrals project scope. Identify key players to engage in Referrals project. Review current workflows and integration points. Hold regular referrals workgroup meetings. Complete Referrals system build and testing, including but not ...
...centers serving residents living in three quadrants of Rochester, NY and in Canandaigua, N.Y. Jordan Health is now seeking a Psychiatric NP/PA who, under the guidance of the Director of Social Emotional and Mental Health/Practice Chief, is primarily responsible for...