Clinical Pharmacist - Medicaid Prior Authorization (NC or MA Licensed)

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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

This position is for a Clinical Pharmacist working in the Medicaid Prior Authorization team. This remote position requires active, unrestricted pharmacist licensure in the State of North Carolina or State of Massachusetts.

The Clinical Pharmacist will:

• 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.

• Collaborate 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. 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.

• Maintain 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.

• Perform 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.

Working hours for this role will be 11:30am-8pm ET M-F, with a weekend on-call rotation.

We offer a 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.

 This is a remote role open to candidates within the United States. Candidate can reside in any state, but must hold active Pharmacist licensure in the State of North Carolina and/or State of Massachusetts and be willing to work 11:30am-8pm ET.

Required Qualifications

• Active pharmacist license that is in good standing in the state of North Carolina or state of Massachusetts

• Demonstrated experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology

• Prior authorization, call center and clinical pharmacy experience.

• 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.

• Flexibility with working a rotating schedule including overtime, weekends, and holidays

Preferred Qualifications

• PGY1/PGY2

• 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

Bachelors of Science - Pharmacy or Pharm.D.

Pay Range

The typical pay range for this role is:

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.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.