Pharmacist - Prior Authorization

Job Description
Job Title: Pharmacist- PA
Location: Remote
Duration:12+ months (with a possibility of extension)
Position Summary:
CVS Health is seeking an experienced Prior Authorization Pharmacist to perform clinical reviews of medication requests and determine coverage appropriateness based on established clinical criteria and guidelines. The pharmacist will review patient and medication information, evaluate prior authorization requests, communicate with providers regarding clinical questions, and ensure timely and accurate documentation of clinical decisions.
The ideal candidate will have strong experience in Prior Authorization review, with a background in PBM, Managed Care, Health Plan, or Specialty Pharmacy environments.
Responsibilities:
Conduct clinical Prior Authorization reviews for prescription and specialty medications using established criteria and guidelines.
Review patient profiles, medication history, diagnosis, drug interactions, and relevant clinical information to determine medical necessity and appropriateness of therapy.
Evaluate authorization requests and supporting clinical documentation submitted by providers.
Contact physicians and healthcare providers to obtain additional clinical information or clarify medication-related questions.
Communicate Prior Authorization decisions and clinical recommendations professionally with providers and other healthcare professionals.
Review and resolve prescription and insurance-related issues, including medication coverage and adjudication concerns.
Accurately document clinical reviews, decisions, interventions, and provider communications in appropriate systems.
Escalate complex clinical cases or questions according to established procedures.
Maintain compliance with applicable pharmacy regulations, HIPAA requirements, quality standards, and organizational policies.
Collaborate with pharmacists, pharmacy technicians, providers, and internal teams to ensure timely resolution of authorization requests.
Manage a high-volume workload while maintaining accuracy, quality, and turnaround-time requirements.
Skills:
Active Pharmacist License in good standing.
2+ years of Prior Authorization review experience REQUIRED.
Strong clinical knowledge of medications, drug therapy, and utilization management principles.
Excellent verbal and written communication skills.
Strong attention to detail and ability to make appropriate clinical decisions based on established criteria.

Work arrangement
Yes