Clinical Pharmacist – Prior Authorization

CVS Health

Clinical Pharmacist reviewing commercial prior authorizations for CVS Health’s pharmacy benefit programs. Applying clinical criteria, coordinating determinations, and consulting providers remotely across the United States.

Posted 8/11/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $45 - $76 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, clinical decision-making, and effective communication with healthcare providers. Proficient in utilizing clinical resources and maintaining knowledge of drug and disease states relevant to pharmacy programs.

Highest-signal resume keywords

Prior Authorization ExperienceClinical Decision-MakingPharmacy Benefit Management (PBM)Microsoft Office ProficiencyActive Pharmacist License

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Resource UtilizationDrug and Disease State KnowledgeCoverage Determination EvaluationInsurance VerificationFormulary Recommendation

Soft Skills

Organizational SkillsDetail OrientationInterpersonal SkillsCommunication SkillsAdaptability

Tools & Technologies

MicromedexLexicompClinical PharmacologyWindows-Based Applications

Certifications & Qualifications

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

Industry Keywords

Prior AuthorizationPharmacy Benefit ManagementSpecialty PharmacyClinical GuidelinesHealthcare Provider Consultation

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, interpret clinical guidelines, consult physicians and healthcare providers, and apply clinical knowledge while following department protocols
Communicate case decisions promptly to healthcare providers, health plans/employers, patients, and other healthcare professionals
Handle inbound and outbound calls to facilitate prior authorization requests, answer inquiries, and resolve escalations
Establish and 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
Consult with pharmacy technicians and physicians regarding medication use and recommend formulary alternatives when requested

Requirements

What you’ll need

2 years’ experience working as a pharmacist in a PBM setting
Current experience working with commercial Prior Authorizations within Caremark PBM
Experience using clinical resources such as Micromedex, Lexicomp, and Clinical Pharmacology
Ability to prioritize, quickly assess, manage multiple tasks, and adapt to changing situations
Excellent organizational skills and strong detail orientation
Strong Microsoft Office skills
Excellent oral and written communication and interpersonal skills
Ability to work independently and make clinical decisions
Experience using MS Office and other Windows-based computer applications
Ability to receive calls from prior authorization pharmacy technicians and/or providers for clinical information
Active pharmacist license in good standing in the state of residence
Bachelor's of Science in Pharmacy or Pharm.D.
Preferred: PGY1/PGY2
Preferred: Prior authorization, call center, and clinical experience
Preferred: Exposure to clinical and analytical problem solving

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 colleagues' physical, emotional, and financial well-being
Comprehensive benefits package for eligible full-time colleagues and their families