Clinical Pharmacist – Medicaid Prior Authorization, NC Licensed

CVS Health

Clinical Pharmacist reviewing prior authorization requests and making coverage determinations for CVS Health’s pharmacy benefit programs. Remote U.S.

Posted 8/11/2026full-timeRemote • North Carolina • 🇺🇸 United StatesMid-LevelSenior💰 $45 - $76 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in evaluating prior authorization requests and making coverage determinations based on clinical criteria. Proficient in utilizing clinical resources and maintaining effective communication with healthcare providers while ensuring compliance with protocols.

Highest-signal resume keywords

Active Pharmacist LicensePrior Authorization ExperienceClinical Resource UtilizationMicrosoft Office ProficiencyOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior AuthorizationClinical PharmacyDrug and Disease State KnowledgeClinical Decision MakingData Collection and Assessment

Soft Skills

Excellent Communication SkillsInterpersonal SkillsAttention to DetailAbility to PrioritizeAdaptability

Tools & Technologies

MicromedexLexicompClinical PharmacologyWindows-Based Applications

Certifications & Qualifications

Bachelor's of Science in PharmacyPharm.D.

Industry Keywords

Caremark PBMHealthcare ProvidersPharmacy TechniciansFormulary Alternatives

About the role

Key responsibilities & impact

Evaluate and review prior authorization requests and render coverage determinations based on clinical criteria and plan design
Verify insurance coverage and eligibility and interpret clinical guideline criteria
Consult physicians and other healthcare providers using clinical knowledge and resources while complying with department protocols
Communicate case decisions promptly to healthcare providers, health plans/employers, patients, and other healthcare professionals
Collaborate with technicians and prior authorization team members to process referrals
Answer clinical questions and collect clinical/medical data for assessments and reviews according to agreed criteria and service level agreements
Handle inbound and outbound calls with technicians, team members, physicians, healthcare providers, and patients
Facilitate prior authorization requests, answer inquiries, and resolve escalations
Maintain professional and technical knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs
Attend training sessions and development meetings and provide on-call and after-hours pharmacist availability as needed, including weekends

Requirements

What you’ll need

Must currently hold and maintain an active, unrestricted pharmacist license in good standing in North Carolina
Current experience with prior authorizations within Caremark PBM
Demonstrated experience using clinical resources such as Micromedex, Lexicomp, and Clinical Pharmacology
Prior authorization, call center, and/or clinical pharmacy experience
Strong Microsoft Office skills
Experience using MS Office and other Windows-based computer applications
Ability to prioritize, quickly assess, manage multiple tasks, and adapt to changing situations
Excellent organizational skills and strong attention to detail
Excellent oral and written communication and interpersonal skills
Ability to work independently and make clinical decisions
Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information
Bachelor's of Science in Pharmacy or Pharm.D.
Preferred: exposure to clinical and analytical problem solving
Preferred: ability to consult with pharmacy technicians and/or physicians regarding medication use and advise on formulary alternatives

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to the base pay range
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