Job Description
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 approved
criteria 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 as
per the health plan/employer agreed criteria within the designated service
level agreements.
*Coordinates timely communication of case decision to physician, health plan/employer, patient and
other healthcare professionals following agreed upon approval and denial management processes.
*Handles inbound phone calls and escalations from physicians or patients regarding Prior
Authorization.
*Establishes and maintains communication among CVS Caremark, health plan and employer group
staff.
*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)
Pay Range
The typical pay range for this role is:
Minimum: 74,600
Maximum: 160,700
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
*6 months 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.
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
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.
Education
*Bachelors degree in Pharmacy
*Doctorate (PharmD) preferred
*License active with no restrictions in state of residence.
Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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