RPh Advisor - Medical Prior Authorization

Job DescriptionReady to take your clinical skills to the next level? Check out this outstanding opportunity for a Clinical Pharmacist with the Specialty Medical Prior Authorization teamThe Clinical Pharmacist 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.Rotating weekends and occasional holidays may be required per business needs. The position is remote.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 RangeThe typical pay range for this role is:Minimum: 78,000Maximum: 168,000Please 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- Active pharmacist license in state of residence in good standing- Currently working within Novologix system, specifically Medical Prior Authorization Operations- Currently working within Aetna PA Salesforce experiencePreferred QualificationsExcellent interpersonal skillsDemonstrated problem solving ability and attention to detailAbility to work effectively in a team environment with great dependabilityExcellent oral and written communication skillsAbility to quickly assess and adapt to constantly changing situationsRequired to possess a high mental agility and alertnessAbility to effectively communicate with pharmacists, other clinical colleagues, healthcare professionals and membersAbility to effectively prioritize work while exhibiting a high level of urgency with all calls and assignmentsFollows all prior authorization procedures to ensure a timely and accurate process on each prior authorizationAbility to effectively train and mentor representatives on the PA teamExecute other PA assignments as delegated by the PA supervisor or managerCall center, PBM, or clinical experienceStrong Microsoft Office skillsEducationBachelor of Pharmacy or PharmD equivalentBusiness OverviewBring 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.

Created: 2025-11-15