, Illinois

Job Description
The Clinical Pharmacist – Specialty Prior Authorizations position is an exciting opportunity to use your clinical knowledge at a Fortune 5 company!

The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. In this role, you will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. This role works from CVS Caremark supported systems and takes inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.

- Collaborating with the Case Review Unit Technician to process referrals, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the healthplan/employer agreed criteria within the designated service level agreements
- Coordinating timely communication of case decision to physician, healthplan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes.
- Handling inbound phone calls and escalations from physicians or patients regarding Prior Authorization
- Maintaining professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit
- Performing other related projects and duties as assigned including on call and after hours pharmacist availability as business requires

We offer a competitive benefit package including vacation, 10 paid holidays per year, health/dental/vision insurance, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at all CVS stores.

Required Qualifications
- At least 1 year experience in specialty medication therapy management or PBM experience
- Active IL pharmacist license that is in good standing
- Must be computer literate – knowledge of Excel and Word.

Preferred Qualifications
- Knowledge of Access, Power Point, and Visio

Bachelor of Pharmacy required. Doctorate of Pharmacy preferred.

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. See Job Description

, Illinois

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses


"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

Similar jobs