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
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 qualified candidates within the United States.
Required Qualifications
Active, unrestricted pharmacist licensure
Current pharmacist experience within Caremark PA Ops required
Ability and willingness to work a flexible hourly schedule to include overtime, weekends, and holidays as needed
Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.
Must be able to multitask and utilize multiple system applications simultaneously.
Must be able to utilize available resources independently and provide high quality work.
Must demonstrate problem solving ability and attention to detail.
Ability to adapt and change with workflow and shifting priorities.
Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the prior authorization team.
Must possess excellent written, verbal, grammar, and listening communication skills.
Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner.
Ability to maintain confidentiality of PHI
Education
BS in Pharmacy or Pharm D
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$50.48 - $84.62This 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.
Skills Required
- Active, unrestricted pharmacist licensure
- Current pharmacist experience within Caremark Prior Authorization Operations
- Bachelor of Science in Pharmacy or Doctor of Pharmacy degree
- Ability and willingness to work flexible hours, including overtime, weekends, and holidays
- Knowledge of Microsoft Office Suite, including Excel and Word
- Keyboard skills
- Ability to multitask across multiple system applications
- Ability to work independently and produce high-quality work
- Problem-solving ability and attention to detail
- Ability to adapt to workflow changes and shifting priorities
- Ability to work effectively in a team and mentor non-clinical staff
- Excellent written, verbal, grammar, listening, and communication skills
- Ability to communicate effectively with a diverse customer base
- Ability to maintain confidentiality of protected health information
- Knowledge of Access, Outlook, PowerPoint, and Visio
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
