Job Title: Pharmacist Operations Advisor – Prior Authorization (Remote)
Location: Remote (Excludes residents of New Mexico and Colorado)
Start Date: September 15, 2025
Duration: 5 months (09/15/2025 to 02/13/2026)
About the Role:Seeking licensed Prior Authorization Pharmacists with PBM (Pharmacy Benefit Management) experience for a fully remote contract opportunity. The Pharmacist Operations Advisor will be responsible for performing clinical reviews of prior authorization requests and supporting care delivery across Commercial Prior Authorization Unit.
Work Schedule:Please indicate preferred shift at the top of the resume.
Key Responsibilities:Conduct clinical and criteria-based reviews of prior authorization requests.
Verify insurance coverage, eligibility, and plan design applicability.
Collaborate with PA technicians and other healthcare providers to ensure timely case resolution.
Handle inbound/outbound calls from physicians, healthcare providers, and members.
Ensure compliance with departmental protocols, approval/denial processes, and privacy guidelines.
Maintain up-to-date clinical and technical knowledge for CVS Specialty and Non-Specialty programs.
Participate in training, development sessions, and on-call coverage as needed.
Required Qualifications:Active Registered Pharmacist License in the state of residence.
1–3 years of experience working in a PBM and/or Prior Authorization setting (required).
Solid understanding of clinical guidelines and managed care principles.
Proficiency with Microsoft Office (Excel and Word; Access, Outlook, and Visio preferred).
Strong multitasking ability using multiple applications simultaneously.
Excellent written, verbal, and interpersonal communication skills.
Proven problem-solving and attention to detail.
Ability to work independently and maintain confidentiality of PHI.
Education Requirements: