Clinical Pharmacist - Aetna Medicaid Prior Authorization (AZ or TX Licensed)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary - Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests. - Promotes and supports quality effectiveness of healthcare and Pharmacy Services. - Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines. - Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria. - Determines appropriateness for medications. Communicates decision to physicians, physician’s office staff, medical management staff, members, and/or pharmacists. - Will perform clinical research to support request. - Performs non-medical research including eligibility verification, COB, and benefits verification. - Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. - Process requests in compliance with various laws and CMS regulations and company policies and procedures. - May communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers. - Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services. - Sedentary work involving significant periods of sitting, tal

Become a part of our caring community The Clinical Programs Pharmacist Lead will be a part of a collaborative Pharmacy Stars team which is accountable for Humana’s Stars patient safety measure performance. The Clinical Pharmacist Lead autonomously develops, implements, and manages clinical program strategies to improve Medicare members' medication adherence and appropriate medication use. The Clinical Pharmacist lead exercises independent judgment and decision making on complex issues regarding job duties and related tasks, works under minimal supervision, and analyzes variable factors to determine the best course of action. Use your skills to make an impact Required Qualifications Degree of Doctor of Pharmacy (PharmD or RPh) from an accredited School of Pharmacy Active, unrestricted pharmacy licensure 5+ years of clinical experience in managed care or pharmacy related field, or equivalent Proficient in Microsoft Office applications (especially Word, Excel, and PowerPoint) Excellent written and oral communication skills Thrives in a fast paced, multi-project work environment while still ensuring attention to detail Successful track record in facilitating and consulting across teams and managing projects Strategic thinking and planning capabilities, organized, and detail-oriented Ability to learn quickly, work under pressure and timeline, work with ambiguity, and make complex decisions as necessary to meet business need Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data Preferred Qualifications Previous experience in Medicare Stars Managed care and/or community pharmacy experience or residency/fellowship Previous experience in clinical program development and leader

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This position is for a Clinical Pharmacist working in the Prior Authorization team. - Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. - Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. - One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. - Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. - Establishes and maintains communicat

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This position is part of our hybrid onsite/work from home business model. Once fully trained (6 weeks) this will be approximately 15% onsite and 85% work from home (approx. 10-15 onsite days per year) Subject to change IF business needs change. On site requirement is located at: 6251 Chancellor Dr, Suite 101, Orlando, FL 32809 Exciting opportunity for a Pharmacist to join our Specialty Mail Service Pharmacy located in Orlando, FL! Specialty pharmacy is an exciting area for Pharmacists, especially at CVS Health! We are a Fortune 10 company and are the one of the largest providers for specialty pharmacy therapy in the United States. If you are a Pharmacist, and enjoy helping people on their path to better health, this may be the role for you! Should you join CVS Health, you will see right away how dedicated we are to providing our Pharmacists with the resources needed to deliver the highest quality patient care. As a Pharmacist for our Specialty Mail Service Pharmacy, you will have the ability to provide exceptional customer service to patients and healthcare professionals while providing leadership and guidance to supporting staff. Our Pharmacists ensure the accurate delivery of pharmaceutical care services, which include drug therapy monitoring, patient education, drug information and chronic disease state management for our clinical programs.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This position is part of our hybrid onsite/work from home business model. Once fully trained (6 months) this will be approximately 25% onsite and 75% work from home. On site requirement is located at: 2700 West Frye Road Chandler, AZ 85224 Exciting opportunity for a Pharmacist to join our Specialty Mail Service Pharmacy located in Chandler, AZ. Specialty pharmacy is an exciting area for Pharmacists, especially at CVS Health! We are a Fortune 10 company and are the one of the largest providers for specialty pharmacy therapy in the United States. If you are a Pharmacist, and enjoy helping people on their path to better health, this may be the role for you! Should you join CVS Health, you will see right away how dedicated we are to providing our Pharmacists with the resources needed to deliver the highest quality patient care. As a Pharmacist for our Specialty Mail Service Pharmacy, you will have the ability to provide exceptional customer service to patients and healthcare professionals while providing leadership and guidance to supporting staff. Our Pharmacists ensure the accurate delivery of pharmaceutical care services, which include drug therapy monitoring, patient education, drug information and chronic disease state management for our clinical programs. We offer a

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Omnicare is a leading provider of pharmacy services to long-term care facilities nationwide, supporting skilled nursing facilities, assisted living communities, and other institutional care settings. As we transition to an independent, standalone organization, we are building and strengthening internal capabilities to support our approximately 6,000 colleagues and multi-state operations. The Omnicare Air Support team provides 24/7 pharmacy support to long-term care dispensing pharmacies nationwide. As an Air Support Pharmacist, you will play an important role in helping ensure medication orders are reviewed accurately, clinically appropriately, and in a timely manner to support safe and efficient delivery to customers. We are seeking a pharmacist who demonstrates strong clinical judgment, attention to detail, and the ability to work effectively in a fast-paced environment. Success in this role requires a commitment to quality, service, compliance, and collaboration. Primary Responsibilities Verify medication orders entered by technician staff for accuracy, completeness, and clinical appropriateness Review new and refill orders to ensure safe and appropriate medication therapy Identify and address drug-drug, drug-disease, drug-food, and allergy-related concerns Document pharmacist interventions and related actions