Job Description
The 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. Responsibilities 1. 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 healthplan/employer agreed criteria within the designated service level agreements. 20 2. Coordinates timely communication of case decision to physician health-plan/employer patient and other healthcare professionals following agreed upon approval denial management processes. 15 3. Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization 50 4. Establishes and maintains communication among CVS Caremark health plan and employer group staff. 5 5. Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit. 5 6. Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. 5 Knowledge of Access Power Point and Visio is preferable. Must be computer literate - knowledge of Excel and Word. Licensed Registered Pharmacist Minimum 3-5 years experience although 5-8 years is preferred. Training dates: Sept 7th through Oct 1 *Possible weekend shift* Max bill rate: 72.00 This is a safety sensitive position. Completion of all screens is required prior to the candidate starting the assignment. Upon acceptance please send the following information: Home address Personal email address Cell phone number A broadband connection and a smartphone are required. The VPN token will be need to be downloaded to the users smartphone. NOTE: They can work from anywhere in the continental U.S
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