Clinical Pharmacist – Prior Authorization

CVS Health

. Collaborate with technicians and prior authorization team members to process referrals, answer clinical questions, and collect clinical/medical data for assessments and reviews .

Posted 9/17/2026full-timeRemote • Texas • United StatesJuniorMid-Level💰 $50 - $85 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Prior Authorization processes within a PBM environment, utilizing clinical resources and maintaining strong communication with healthcare providers. Possesses a solid foundation in pharmacy knowledge, with the ability to make clinical decisions and manage multiple tasks effectively.

Highest-signal resume keywords

Prior Authorization ExperienceClinical Resource UtilizationPharmacist LicenseMicrosoft Office ProficiencyCommunication Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical Decision MakingDrug and Disease State KnowledgeCoverage Determination EvaluationInsurance VerificationClinical Guideline Interpretation

Soft Skills

Organizational SkillsDetail OrientationInterpersonal SkillsAdaptabilityIndependent Work

Tools & Technologies

MicromedexLexicompClinical PharmacologyWindows Based Applications

Certifications & Qualifications

Active Pharmacist LicenseBachelor's of Science - PharmacyPharm.D.

Industry Keywords

PBM SettingPrior AuthorizationHealthcare ProvidersSpecialty PharmacyCall Center Experience

About the role

Key responsibilities & impact

Collaborate with technicians and prior authorization team members to process referrals, answer clinical questions, and collect clinical/medical data for assessments and reviews
Evaluate and review prior authorization requests and render coverage determinations based on clinical criteria and plan design
Verify insurance coverage and eligibility and interpret clinical guideline criteria
Consult physicians and other healthcare providers while applying clinical knowledge and department protocols
Communicate case decisions promptly to healthcare providers, health plans/employers, patients, and other healthcare professionals
Perform inbound and outbound calls to facilitate prior authorization requests, answer inquiries, and resolve escalations
Maintain communication among CVS Caremark, health plan, and employer group staff
Maintain professional and technical knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs
Attend training sessions and development meetings
Provide on-call and after-hours pharmacist availability as needed
Perform other related projects and duties as assigned

Requirements

What you’ll need

2 years’ experience working as a pharmacist in a PBM setting
Current experience working within Commercial Prior Authorizations in Caremark PBM environment
Demonstrated 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 and 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
Bachelor's of Science - Pharmacy or Pharm.D.
Preferred: PGY1/PGY2
Preferred: Prior authorization, call center and clinical experience
Preferred: Exposure to clinical and analytical problem solving
Preferred: Ability to consult with pharmacy technicians and/or physicians regarding medication use and formulate alternatives

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility