Collaborates with the technicians and prior authorization team members to process referrals
Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design
Guarantee that decisions regarding cases are conveyed promptly and efficiently
Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients
Establishes and maintains communication among CVS Caremark, health plan, and employer group staff
Maintains professional and technical knowledge of drug and disease states
Performs other related projects and duties as assigned

Active, unrestricted pharmacist licensure
Current pharmacist experience within Caremark PA Ops required
Ability and willingness to work a flexible hourly schedule to include overtime, weekends, and holidays as needed
Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable
Keyboard skills essential
Must be able to multitask and utilize multiple system applications simultaneously
Must be able to utilize available resources independently and provide high quality work
Must demonstrate 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
Must possess excellent written, verbal, grammar, and listening communication skills
Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner
Ability to maintain confidentiality of PHI (Protected Healthcare Information)

Clinical Pharmacist – Prior Authorization

Key skills