Clinical Pharmacist – Prior Authorization

CVS Health

. Collaborate with technicians and prior authorization team members to process referrals .

Posted 9/21/2026full-timeRemote • United StatesMid-LevelSenior💰 $45 - $76 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in prior authorization processes, clinical assessments, and effective communication with healthcare providers and patients. Holds active pharmacist licensure and possesses strong problem-solving skills while maintaining confidentiality of PHI.

Highest-signal resume keywords

Active Pharmacist LicensurePrior Authorization ExperienceMicrosoft Office Suite ProficiencyClinical Knowledge of Drug and Disease StatesExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentPrior Authorization ProcessingInsurance Coverage VerificationData CollectionProblem-SolvingAttention to DetailMultitaskingKeyboard Skills

Soft Skills

Team CollaborationMentorshipAdaptabilityCustomer Service

Tools & Technologies

Microsoft ExcelMicrosoft WordMicrosoft AccessMicrosoft OutlookMicrosoft PowerPointMicrosoft Visio

Certifications & Qualifications

BS in PharmacyPharm D

Industry Keywords

PHI ConfidentialityHealthcare ProvidersClinical GuidelinesSpecialty PharmacyNon-Specialty Pharmacy

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 clinical 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
Interpret clinical guideline criteria and consult physicians and other healthcare providers
Apply clinical knowledge and resources while complying with department protocols
Convey 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
Complete related projects and duties, attend training and development meetings, and provide on-call and after-hours pharmacist availability as needed

Requirements

What you’ll need

Active, unrestricted pharmacist licensure
Current pharmacist experience within Caremark PA Ops required
Ability and willingness to work a flexible hourly schedule, including overtime, weekends, and holidays as needed
Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, and Visio preferable
Keyboard skills essential
Ability to multitask and utilize multiple system applications simultaneously
Ability to utilize available resources independently and provide high quality work
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
Excellent written, verbal, grammar, and listening communication skills
Ability to effectively communicate with a diverse customer base in a friendly and confident manner
Ability to maintain confidentiality of PHI
BS in Pharmacy or Pharm D
Qualified applicants with arrest or conviction records will be considered in accordance with federal, state, and local laws

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