Clinical Pharmacist - Prior Authorization (Remote) - CVS Health - Join a Fortune 6 Company and Transform Healthcare

About CVS Health and Our Purpose At CVS Health, we're driven by a singular purpose: Bringing our heart to every moment of your health. As a Fortune 6 company, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose is at the heart of everything we do, guiding our commitment to making healthcare more personal, convenient, and affordable. Job Summary We're seeking a highly skilled and compassionate Clinical Pharmacist to join our Prior Authorization team. As a Clinical Pharmacist with CVS Health, you'll have the opportunity to take your skills to the next level and make a meaningful impact on patient care. This is a remote role, offering the flexibility to work from anywhere in the United States. Key Responsibilities Prior Authorization Reviews: Evaluate and review prior authorization requests, rendering coverage determinations based on clinical criteria and plan design. This includes 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. Communication and Collaboration: 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. You'll also handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and patients to facilitate prior authorization requests, answer inquiries, and resolve escalations. Professional Development: Maintain professional and technical knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs. You'll also attend training sessions and development meetings, and provide on-call and after-hours pharmacist availability as needed. Clinical Decision-Making: Make timely and accurate clinical decisions, ensuring that patients receive the necessary care and treatment. You'll work independently, utilizing your clinical expertise and judgment to make informed decisions. Requirements and Qualifications Essential Qualifications: Pharmacy Experience: 2 years of experience working as a pharmacist in a PBM setting, including prior authorization experience in a PBM environment. Clinical Resources: Demonstrated experience using clinical resources, such as Micromedex, Lexicomp, and Clinical Pharmacology. Organizational and Communication Skills: Excellent organizational skills, strong detail orientation, and excellent oral and written communication skills. Technical Skills: Strong Microsoft Office skills, experience using MS Office and other Windows-based computer applications. Licensure: Active pharmacist license in good standing in the state of residence. Preferred Qualifications: Post-Graduate Training: PGY1/PGY2 experience. Prior Authorization and Clinical Experience: Prior authorization, call center, and clinical experience. Analytical and Problem-Solving Skills: Exposure to clinical and analytical problem-solving. Consultation and Collaboration: Ability to consult with pharmacy technicians and/or physicians regarding medication use and advise on appropriate formulary alternatives. Education Bachelor's of Science - Pharmacy or Pharm. D. Compensation and Benefits We offer a competitive benefit package, including: Salary: The typical pay range for this role is $34.76 - $99.81 per hour or annual salary, depending on experience and qualifications. Medical, Dental, and Vision Insurance: Comprehensive medical, dental, and vision benefits. 401(k) and Employee Stock Purchase Plan: Eligible employees may enroll in our 401(k) retirement savings plan and Employee Stock Purchase Plan. Paid Time Off and Holidays: Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Tuition Reimbursement and Education Assistance: Opportunities for education assistance and tuition reimbursement. CVS Store Discount: Discounts at all CVS stores. Work Environment and Culture At CVS Health, we're committed to creating a work environment that's inclusive, supportive, and empowering. Our company culture is built on our Heart At Work Behaviors, which guide our interactions and decision-making. We offer: Remote Work: This is a remote role, offering the flexibility to work from anywhere in the United States. Professional Development: Opportunities for growth and development, including training sessions and development meetings. Diverse and Inclusive Community: A diverse and inclusive community that values and respects individual differences. Career Growth Opportunities and Learning Benefits At CVS Health, we're committed to helping our employees grow and develop their skills. We offer: Career Advancement Opportunities: Opportunities for career advancement and professional growth. Training and Development: Comprehensive training and development programs. Mentorship: Opportunities for mentorship and coaching. Why Join CVS Health? By joining CVS Health, you'll become part of a team that's dedicated to transforming healthcare and making a positive impact on patient care. You'll have the opportunity to: Make a Difference: Make a meaningful difference in the lives of patients and customers. Grow and Develop: Grow and develop your skills and expertise. Work with a Purpose: Work with a purpose, guided by our Heart At Work Behaviors. How to Apply If you're a motivated and compassionate Clinical Pharmacist looking to take your skills to the next level, we encourage you to apply for this exciting opportunity. Please submit your application by October 18, 2024. Apply To This Job Apply for this job