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CVS Health Pharmacist - Specialty Appeals in Texas

Job Description

Ready to take your Clinical Pharmacist skills to the next level with a Fortune 4 Company? Check out this outstanding opportunity with CVS Health!The Clinical Pharmacist- Appeals is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply clinical knowledge to plan approvedcriteria for prospective and concurrent reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations. Responsibilities :Collaborates with the CRU Technician to process referrals, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews asper the health plan/employer agreed criteria within the designated servicelevel agreements. *Coordinates timely communication of case decision to physician, health plan/employer, patient andother healthcare professionals following agreed upon approval and denial management processes. *Handles inbound phone calls and escalations from physicians or patients regarding PriorAuthorization. *Establishes and maintains communication among CVS Caremark, health plan and employer groupstaff. *Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit. *Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required.9:30am- 6:00pm CT M-F (weekend rotation)

Required Qualifications

*1+ yeare experience working Specialty Appeals. *1 or more years exposure to clinical and analytical problem solving. *Experience in medication review, patient counseling and identification of drug related problems.

Preferred Qualifications

  • Clinical pharmacy knowledge. * Data review. * Ability to prioritize and manage multiple tasks. * Flexible. * Excellent organizational skills. Strong detail orientation. * Strong Microsoft Office skills. Excellent oral and written communication skills and interpersonal skills. * Ability to balance clinical knowledge and customer service demands. * Ability to make own clinical decisions. * Demonstrated problem solving ability and attention to detail. * Must be a team player and very dependable. * Excellent oral and written communication skills. * Ability to quickly assess and adapt to constant changing situations.


*Bachelors degree in Pharmacy *Doctorate (PharmD) preferred *Illinois license active with no restrictions.

Business Overview

At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.