Clinical Pharmacist - Prior Authorization

About the role

This position is for a Clinical Pharmacist working in the Prior Authorization team at CVS Health. The role involves collaborating with technicians and prior authorization team members to process referrals, evaluate and review prior authorization requests, and communicate decisions to various stakeholders.

Responsibilities

• Collaborate with technicians and prior authorization team members to process referrals, answer clinical questions, and collect necessary clinical/medical data.
• Evaluate and review prior authorization requests, rendering coverage determinations based on clinical criteria and plan design.
• Verify insurance coverage and eligibility, interpret clinical guideline criteria, consult physicians and other healthcare providers, and utilize clinical knowledge and resources while complying with department protocols.
• Guarantee timely and efficient conveyance of decisions to healthcare providers, health plans/employers, patients, and other healthcare professionals following approved processes.
• Handle 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 resolve escalations.
• Establish and maintain communication among CVS Caremark, health plan, and employer group staff.
• 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 and handle 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.

Requirements

Active, unrestricted pharmacist licensure, current pharmacist experience within Caremark PA Ops, knowledge of Microsoft Office Suite, keyboard skills, ability to multitask, utilize multiple system applications, maintain confidentiality of PHI, BS in Pharmacy or Pharm D.

Qualifications

Flexible hourly schedule to include overtime, weekends, and holidays as needed, excellent written, verbal, grammar, and listening communication skills, 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.

Skills

Must be able to utilize available resources independently and provide high quality work, demonstrate problem-solving ability and attention to detail, and maintain confidentiality of PHI.

Benefits

The typical pay range for this role is $50.48 - $84.62. 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 belongs. 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. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 07/19/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.