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RPh Advisor - Commercial Specialty at CVS Health - ApplyBlast

RPh Advisor - Commercial Specialty

CVS Health

4 months ago

3.2 on Glassdoor

Remote

Full Time

Senior

0 applicants

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About this role

The Pharmacist/Clinician at CVS Health conducts clinical reviews of medical data to perform prior authorizations in compliance with policy and procedure. This operation-based role involves evaluating coverage determinations, consulting with healthcare providers, and managing inbound calls regarding pending or denied requests. Candidates must maintain professional knowledge of drug and disease states while providing on-call availability for urgent authorization needs.

Responsibilities

Evaluate and review prior authorization requests based on clinical criteria
Render coverage determinations and verify insurance eligibility
Consult physicians and healthcare providers regarding pending cases
Manage inbound and outbound calls to resolve authorization escalations
Provide on-call availability for urgent prior authorization requests

Skills

Qualifications

BS in PharmacyDoctorate in Pharmacy (Pharm D)Active Unrestricted Pharmacist License

About CVS Health

cvshealth.com

Headquarters

Woonsocket, Rhode Island, United States

Company Size

10001+ employees

Founded

1963

View Profile

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.