Clinical Pharmacist - Prior Authorization

Responsibilities: Evaluate and review prior authorization requests to render coverage determinations based on clinical criteria and plan design. Collaborate with healthcare providers and internal teams to process referrals and communicate decisions efficiently.

Requirements: Requires an active, unrestricted pharmacist licensure and a BS in Pharmacy or Pharm D. Candidates must have current experience within Caremark PA Ops and proficiency in Microsoft Office Suite.

Key skills: Prior Authorization, Clinical Assessment, Insurance Verification, Drug and Disease State Knowledge, Microsoft Excel, Microsoft Word, Multitasking, Problem Solving, Attention to Detail, Written Communication, Verbal Communication, PHI Confidentiality, Mentorship, Clinical Review

Keywords: Clinical Pharmacist, Prior Authorization, CVS Caremark, Pharmacy Benefit Management, PHI, Specialty Pharmacy, Non-Specialty Pharmacy, Case Review Unit, Clinical Guidelines, Healthcare Provider Communication, Medical Data Collection, Coverage Determination