Clinical Pharmacist in Work At Home Texas

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 Ready to take your clinical skills to the next level? Check out this outstanding opportunity for a Medicaid Prior Authorization Pharmacist with Aetna! This is a Clinical Pharmacist position supporting Medicaid Prior Authorization. An active TX or AZ pharmacist license that is in good standing is required. New hire is required to obtain the secondary license (AZ or TX) within 90 days of hire . We are hiring for the 10:30 am - 7:00 pm CST shift (post training). The training schedule is: 10:00 am - 6:30 pm CST. You will be required to work one Saturday every 4-6 weeks and occasional holidays. This is a fully remote position open to qualified candidates within the United States who currently hold active, unrestricted TX or AZ pharmacist licensure. Required Qualifications - Active and unrestricted TX and/or AZ pharmacist license - New hire is required to obtain the secondary license (AZ or TX) within 90 days of hire . - Demonstrated experience with clinical decision-making while applying evidence-based clinical guidelines/criteria; utilizing formularies/preferred drug lists. - Experience working in a high production, remote team environment - 3+ years experience working as a pharmacist or completion of PGY1 managed care residency, includin

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

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 Revenue Integrity is seeking a Lead Director, Informatics (Performance Reporting & Insights) to lead the development and delivery of enterprise risk adjustment analytics and business intelligence solutions. This role transforms complex clinical, operational, and risk adjustment data into actionable insights that will drive provider performance, program efficiency, and executive decision-making. This leader will be responsible for creating action through data storytelling, advanced visualizations, and helping to advance the organization’s reporting strategy through AI and automation. This This role is customer-facing and will provide thought leadership and vision partnership to areas such as Market leads, Finance, Clinical, and Operational partners. The leader must also provide technical guidance to staff on BI tool input modeling and calculations. Key Responsibilities Risk Adjustment Performance Reporting Accountable for timely and accurate sharing of risk adjustment KPIs, trends, and performance drivers at a market, plan, and provider level through dashboards and reporting tools Quantify drivers of risk movement and surface those insights to business leaders for action Assess performance against operational and organizational objectives, including appropriate benchmarking and goal setting <