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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

POSITION SUMMARY:

The Clinical Appeals 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 in order to complete appeal reviews.

Responsibilities

1. Collaborates with the Commercial Specialty Technician to process referrals, including answering clinical questions, 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.

2. Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes.

3. Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization

4. Establishes and maintains communication among CVS Caremark, health plan and employer group staff.

5. Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Commercial Specialty Appeals Team.

6. Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required.

Required Qualifications

• 2 years’ experience working as a pharmacist in a PBM setting.

• Demonstrated experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology

• Prior authorization experience in a PBM setting.

• Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations.

• Excellent organizational skills. Strong detail orientation.

• Strong Microsoft Office skills.

• Excellent oral and written communication skills and interpersonal skills.

• Ability to work independently and make clinical decisions.

• Experience using MS Office and other Windows based computer applications.

• Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.

• Active pharmacist license that is in good standing in the state of residence.

Preferred Qualifications

Knowledge of Access, Power Point, and Visio is preferable.

5+ years prior authorization experience in PBM setting

Education

BS in Pharmacy or PharmD

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$55.53 - $93.08

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.

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.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .

+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 11/26/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.