Clinical Pharmacist – AMA Dual

CVS Health

Clinical Pharmacist responsible for reviewing Medicare-Medicaid coverage determinations at CVS Health. Engage in various clinical programs while working remotely within the U.S.

Posted 5/19/2026full-timeRemote • Arizona, Idaho, Texas • 🇺🇸 United StatesJunior💰 $106,200 - $225,000 per yearWebsite

About the role

Key responsibilities & impact

Complete Clinical Reviews and provide a determination of Medicare-Medicaid Coverage Determination/Redetermination
Responsible for support and input to clinical programs
Continually monitor the quality and efficiency of the Prior Authorization process
Provide input to clinical content of new programs
Complete all annual NCQA, Aetna required and Quarterly IRR training requirements
Responsible for supporting / providing clinical expertise related to formulary decisions
Assist Member Services and other internal customers in responding to pharmacy-related inquiries
Maintain open lines of communication with other functional areas/departments
Stay current with clinical literature and guidelines

Requirements

What you’ll need

1+ year managed care pharmacist experience (Medicaid and/or Medicare) and/or completion of PGY1 managed care residency
1+ year of previous clinical pharmacy experience
Demonstrated proficiency in Microsoft Excel, Word, Outlook, and SharePoint
Superior written and verbal communication skills
Active Registered Pharmacist license is required in State of Residence

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

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 & Tools

clinical reviewsMedicare coverage determinationMedicaid coverage determinationPrior Authorization processclinical content developmentformulary decisionsclinical pharmacy experiencemanaged care pharmacyPGY1 managed care residency

Soft Skills

communication skillswritten communicationverbal communicationinterpersonal skillsorganizational skills

Certifications

Registered Pharmacist license