<h1>RPh Advisor - Commercial Specialty</h1><p><strong>Location:</strong> Work At Home-Texas</p><p><strong>Remote Type:</strong> Remote</p><p><strong>Time Type:</strong> Full time</p><h3>Job Description</h3><p>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.</p><p></p><p></p><p></p><p><b>Position Summary:</b></p><p>The Pharmacist/Clinician is an operation-based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Authorization team and member services department, as well as provide on-call after hours availability for urgent Prior Authorization request as needed.</p><p></p><p>Responsibilities:</p><p><span>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. </span></p><p></p><p><span>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. (60%)</span></p><p></p><p><span>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. 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. (25%)</span></p><p></p><p><span>Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Commercial Specialty line of business.</span><span> </span> <span>Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed. (5%)</span></p><p></p><p><span>This is a remote role open to qualified candidates within the United States.</span></p><p></p><p><b>Education:</b></p><p>Required: BS Pharmacy</p><p>Preferred: Doctorate - Pharm D</p><p>Active, unrestricted pharmacist license required within state of practice/residence</p><p></p><p><b>Prior Work Experience:</b></p><p>Required: 1 to 3 years</p><p>Preferred: 3 to 5 years</p><p></p><p><b>Required Skills & Other Minimum Required Qualifications: </b></p><ul><li><p><span>Licensed Registered Pharmacist</span></p></li><li><p><span>Current pharmacist experience within Caremark Commercial Specialty required</span></p></li><li><p><span>Ability and willingness to work a flexible hourly schedule to include overtime, weekends, and holidays as needed</span></p></li><li><p><span>Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.</span></p></li><li><p><span>Must be able to multitask and utilize multiple system applications simultaneously.</span></p></li><li><p><span>Must be able to utilize available resources independently and provide high quality work.</span></p></li><li><p><span>Must demonstrate problem solving ability and attention to detail.</span></p></li><li><p><span>Ability to adapt and change with workflow and shifting priorities.</span></p></li><li><p><span>Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the prior authorization team.</span></p></li><li><p><span>Must possess excellent written, verbal, grammar, and listening communication skills.</span></p></li><li><p><span>Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner.</span></p></li><li><p><span>Ability to maintain confidentiality of PHI (Protected Healthcare Information).</span></p></li></ul><p></p><p><b>Essential Functions: </b></p><p><span>Regular and predictable attendance</span></p><p><span>Colleague will be required to work mandatory overtime/extended work week when needed to support business needs</span></p><p><span>Colleague will be required to travel when needed</span></p><p><span>Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.</span></p><p><span>Adhere to all policies and procedures</span></p><p><span>Attend ongoing training and development meetings</span></p><p></p><p><b>Physical Requirements:</b></p><p><span>Sits at desk for long periods of time (up to 100%)</span></p><p><span>Talking on phone for extended periods of time (up to 100%)</span></p><p><span>Computer use for extended periods of time (100%)</span></p><p><span>Reading a computer screen (up to 100%)</span></p><p></p><p></p><p></p><p><b><span>Anticipated Weekly Hours</span></b></p>40<p></p><p></p><p><b>Time Type</b></p>Full time<p></p><p></p><p><b>Pay Range</b></p><p>The typical pay range for this role is:</p><p></p>$50.48 - $84.62<p></p><p>This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. <br /> </p><p>Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p></p><p><b>Great benefits for great people</b></p><p></p><p>We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.<br /><br /></p>This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.<p><span><br />Additional details about available benefits are provided during the application process and on </span><a><span><u>Benefits Moments</u></span></a><span>.<br /><br /></span></p>We anticipate the application window for this opening will close on: 07/13/2026<p></p><p></p><p>Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p>