Clinical Pharmacist - Commercial Appeals

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Job Description

Ready to take your Clinical Pharmacist skills to the next level with a Fortune 4 company? Check out this outstanding opportunity for a Clinical Pharmacist with CVS Health.

This position is for a Clinical Pharmacist working on the Commercial Appeals team. The pharmacist's primary role is reviewing Appeals cases and working with Medical Affairs to render coverage determinations based on clinical criteria and medical necessity, utilizing clinical judgment/discretion.

Work is computer based and includes making phone calls to (and receiving phone calls from) providers for clinical information.

Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for Appeals cases - in collaboration with Medical Affairs.

Organize workload, sets priorities, completes assignments in a timely manner and utilizes clinical resources appropriately while complying with department protocols.

The basic function of the pharmacist is to review and complete Appeals as per policy and procedure. Collaboration with Medical Affairs. Provide on-call weekend pharmacist availability and provide internal pharmacist support to the Appeals team.

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.

Pay Range

The typical pay range for this role is:

Minimum: 78,000

Maximum: 168,000

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

Required Qualifications

• 2 years' experience working as a pharmacist in a PBM setting.

• Current experience with CVS Health Commercial Appeals

• Experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology

• Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations.

• Excellent organizational skills. Strong detail orientation.

• Strong Microsoft Office skills. Excellent oral and written communication skills and interpersonal skills.

• Ability to work independently and make clinical decisions.

• Experience using MS Office and other Windows based computer applications.

• Ability to make phone calls to & receive phone calls from providers for clinical information.

• Active pharmacist license that is in good standing in the state of residence.

Preferred Qualifications

• PGY1/PGY2

• Prior authorization, call center and clinical experience.

• Exposure to clinical and analytical problem solving.

• Ability to consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.

Education

Bachelor's of Science - Pharmacy or Pharm.D.

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. 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.

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Company info

CVS Health.
Website : https://www.cvshealth.com