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Remote Pharmacist/Clinician – Prior Authorization

Location: Fully Remote – Continental U.S.
Exclusions: New Mexico and Colorado
Job Type: Full-Time / Contract

Work Setting: Fully Remote – Never Required to Come Onsite

Position Summary

We are seeking an experienced Pharmacist/Clinician to perform criteria-based and clinical review of prior authorization requests within a CVS Caremark-supported environment.

The Pharmacist/Clinician will apply clinical knowledge and plan criteria to review cases, render coverage determinations, communicate decisions to providers and members, and support the Prior Authorization team. This position involves both clinical case review and high-volume inbound/outbound provider communication.

Previous PBM, Managed Care, or Health Plan experience is strongly preferred.

Schedule

Available Schedules

Candidates will work one of the following schedules:

• Sunday–Thursday: 10:30 AM–7:00 PM CST
• Sunday–Thursday: 11:00 AM–7:30 PM CST
• Sunday–Thursday: 11:30 AM–8:00 PM CST
• Tuesday–Saturday: 10:30 AM–7:00 PM CST
• Tuesday–Saturday: 11:00 AM–7:30 PM CST
• Tuesday–Saturday: 11:30 AM–8:00 PM CST

One weekend day is required each week.

Training

Training Dates: November 9, 2026 – December 4, 2026
Training Schedule: Monday–Friday, 8:00 AM–4:30 PM CST

Candidates must be available for the entire training period and able to work their assigned schedule following training.

Key Responsibilities

Prior Authorization & Clinical Review – 60%

• Evaluate and review prior authorization requests.
• Render coverage determinations based on clinical criteria and plan design.
• Verify insurance coverage and eligibility.
• Interpret clinical guideline criteria and apply appropriate clinical knowledge.
• Consult with physicians and other healthcare providers as necessary.
• Ensure PA decisions are communicated promptly and accurately to providers, health plans/employers, patients, and other healthcare professionals.
• Follow established approval and denial management processes and department protocols.

PA Team Collaboration & Provider Communication – 25%

• Collaborate with technicians and Prior Authorization team members to process referrals.
• Answer clinical questions and obtain appropriate clinical/medical information required for case reviews.
• Perform inbound and outbound calls with:
• Physicians
• Healthcare providers
• Patients
• Prior Authorization team members
• Technicians
• Facilitate PA requests, answer inquiries, and resolve escalations.
• Handle approximately 50 calls per day.
• Manage approximately 40 prior authorization cases per day.

Clinical Knowledge – 10%

• Maintain current professional and technical knowledge of:
• Drug therapies
• Disease states
• Specialty Pharmacy
• Non-Specialty Pharmacy
• Apply current clinical knowledge to Commercial Specialty Pharmacy programs.

Other Duties – 5%

• Attend required training and development meetings.
• Participate in assigned projects.
• Provide on-call/after-hours pharmacist availability as needed.

Required Qualifications

• Active Pharmacist license in the candidate's state of practice/residence.
• Bachelor's Degree in Pharmacy (BS Pharmacy) required.
• PharmD preferred.
• 2+ years of prior authorization review experience strongly preferred.
• Previous PBM, Managed Care, or Health Plan experience strongly preferred.
• Previous pharmacy experience required.
• Appropriate state pharmacist license required.
• Basic computer skills.
• Strong organizational and interpersonal skills.
• Excellent attention to detail.
• Strong written and verbal communication skills.
• Ability to perform high-volume clinical reviews.
• Ability to communicate PA determinations with physicians, providers, and/or members.
• Ability to work independently in a fully remote environment.

Preferred Experience

Ideal candidates will have experience with:

• PBM environments
• Prior Authorization
• Managed Care
• Health Plans
• Specialty Pharmacy
• Clinical criteria-based reviews
• Coverage determinations
• Provider communication
• High-volume PA processing

Experience with platforms such as Caremark, RxClaim, Facets, GuidingCare, or similar systems is highly desirable.

Remote Work Requirements

This is a fully remote position. Candidates must meet all remote-work requirements:

• Must live in the continental United States.
• New Mexico and Colorado candidates are excluded.
• Must provide their own reliable, high-speed internet.
• Minimum internet speed:
• 25 Mbps download
• 3 Mbps upload
• Internet speed must be verified through Speedtest.net.
• Must provide the internet provider name and download/upload speeds.
• A smartphone is required because the VPN token must be downloaded to the smartphone.
• Must have a sufficient, private workspace with a door.
• Workspace must be dedicated to CVS Health business during working hours.
• Workspace must prevent others in the household from accessing or viewing CVS Health equipment, information, documents, or computer screens.
• Telephone conversations must not be overheard by others.
• Candidate must maintain stable living accommodations.
• Candidate must understand that the assignment could potentially be changed to an in-office assignment.
• Candidate must follow CVS Health Teleworker Privacy Practices.

Resume Submission Requirements

The following MUST be included at the TOP of the resume:

1. Active Pharmacist License
• State
• License number
• Expiration date
2. Internet Speed Test Screenshot
• Screenshot from Speedtest.net
• Internet provider
• Download speed
• Upload speed
3. Completed Candidate Questionnaire

Candidate Questionnaire

Please complete all questions before submitting the candidate:

1. What state(s) do you currently hold an active Pharmacist license in?
2. How many years of Pharmacist experience do you have?
3. How many years of Prior Authorization experience do you have?
4. Describe your PBM, Managed Care, or Health Plan experience.
5. Have you reviewed Specialty Pharmacy prior authorizations? If yes, please specify the therapeutic areas.
6. What pharmacy systems and platforms have you used?
   Examples: Caremark, RxClaim, Facets, GuidingCare, etc.
7. What volume of prior authorization reviews did you complete daily in your most recent role?
8. Have you communicated PA determinations directly with physicians, providers, or members? Please explain.
9. Do you have a private workspace in your home with a door?
10. Can you attend training from November 9, 2026 – December 4, 2026, Monday–Friday, 8:00 AM–4:30 PM CST, and work the assigned schedule following training?
    Yes / No

Important Dates

Last Offer Date: October 12, 2026
Last Acceptance Date: October 15, 2026
Candidate MUST Clear Prior To: October 30, 2026

Class Start Date: November 9, 2026

Remote Pharmacist/Clinician – Prior Authorization

Location: Fully Remote – Continental U.S.
Exclusions: New Mexico and Colorado
Job Type: Full-Time / Contract

Work Setting: Fully Remote – Never Required to Come Onsite

Position Summary

We are seeking an experienced Pharmacist/Clinician to perform criteria-based and clinical review of prior authorization requests within a CVS Caremark-supported environment.

The Pharmacist/Clinician will apply clinical knowledge and plan criteria to review cases, render coverage determinations, communicate decisions to providers and members, and support the Prior Authorization team. This position involves both clinical case review and high-volume inbound/outbound provider communication.

Previous PBM, Managed Care, or Health Plan experience is strongly preferred.

Schedule

Available Schedules

Candidates will work one of the following schedules:

• Sunday–Thursday: 10:30 AM–7:00 PM CST
• Sunday–Thursday: 11:00 AM–7:30 PM CST
• Sunday–Thursday: 11:30 AM–8:00 PM CST
• Tuesday–Saturday: 10:30 AM–7:00 PM CST
• Tuesday–Saturday: 11:00 AM–7:30 PM CST
• Tuesday–Saturday: 11:30 AM–8:00 PM CST

One weekend day is required each week.

Training

Training Dates: November 9, 2026 – December 4, 2026
Training Schedule: Monday–Friday, 8:00 AM–4:30 PM CST

Candidates must be available for the entire training period and able to work their assigned schedule following training.

Key Responsibilities

Prior Authorization & Clinical Review – 60%

• Evaluate and review prior authorization requests.
• Render coverage determinations based on clinical criteria and plan design.
• Verify insurance coverage and eligibility.
• Interpret clinical guideline criteria and apply appropriate clinical knowledge.
• Consult with physicians and other healthcare providers as necessary.
• Ensure PA decisions are communicated promptly and accurately to providers, health plans/employers, patients, and other healthcare professionals.
• Follow established approval and denial management processes and department protocols.

PA Team Collaboration & Provider Communication – 25%

• Collaborate with technicians and Prior Authorization team members to process referrals.
• Answer clinical questions and obtain appropriate clinical/medical information required for case reviews.
• Perform inbound and outbound calls with:
• Physicians
• Healthcare providers
• Patients
• Prior Authorization team members
• Technicians
• Facilitate PA requests, answer inquiries, and resolve escalations.
• Handle approximately 50 calls per day.
• Manage approximately 40 prior authorization cases per day.

Clinical Knowledge – 10%

• Maintain current professional and technical knowledge of:
• Drug therapies
• Disease states
• Specialty Pharmacy
• Non-Specialty Pharmacy
• Apply current clinical knowledge to Commercial Specialty Pharmacy programs.

Other Duties – 5%

• Attend required training and development meetings.
• Participate in assigned projects.
• Provide on-call/after-hours pharmacist availability as needed.

Required Qualifications

• Active Pharmacist license in the candidate's state of practice/residence.
• Bachelor's Degree in Pharmacy (BS Pharmacy) required.
• PharmD preferred.
• 2+ years of prior authorization review experience strongly preferred.
• Previous PBM, Managed Care, or Health Plan experience strongly preferred.
• Previous pharmacy experience required.
• Appropriate state pharmacist license required.
• Basic computer skills.
• Strong organizational and interpersonal skills.
• Excellent attention to detail.
• Strong written and verbal communication skills.
• Ability to perform high-volume clinical reviews.
• Ability to communicate PA determinations with physicians, providers, and/or members.
• Ability to work independently in a fully remote environment.

Preferred Experience

Ideal candidates will have experience with:

• PBM environments
• Prior Authorization
• Managed Care
• Health Plans
• Specialty Pharmacy
• Clinical criteria-based reviews
• Coverage determinations
• Provider communication
• High-volume PA processing

Experience with platforms such as Caremark, RxClaim, Facets, GuidingCare, or similar systems is highly desirable.

Remote Work Requirements

This is a fully remote position. Candidates must meet all remote-work requirements:

• Must live in the continental United States.
• New Mexico and Colorado candidates are excluded.
• Must provide their own reliable, high-speed internet.
• Minimum internet speed:
• 25 Mbps download
• 3 Mbps upload
• Internet speed must be verified through Speedtest.net.
• Must provide the internet provider name and download/upload speeds.
• A smartphone is required because the VPN token must be downloaded to the smartphone.
• Must have a sufficient, private workspace with a door.
• Workspace must be dedicated to CVS Health business during working hours.
• Workspace must prevent others in the household from accessing or viewing CVS Health equipment, information, documents, or computer screens.
• Telephone conversations must not be overheard by others.
• Candidate must maintain stable living accommodations.
• Candidate must understand that the assignment could potentially be changed to an in-office assignment.
• Candidate must follow CVS Health Teleworker Privacy Practices.

Resume Submission Requirements

The following MUST be included at the TOP of the resume:

1. Active Pharmacist License
• State
• License number
• Expiration date
2. Internet Speed Test Screenshot
• Screenshot from Speedtest.net
• Internet provider
• Download speed
• Upload speed
3. Completed Candidate Questionnaire

Candidate Questionnaire

Please complete all questions before submitting the candidate:

1. What state(s) do you currently hold an active Pharmacist license in?
2. How many years of Pharmacist experience do you have?
3. How many years of Prior Authorization experience do you have?
4. Describe your PBM, Managed Care, or Health Plan experience.
5. Have you reviewed Specialty Pharmacy prior authorizations? If yes, please specify the therapeutic areas.
6. What pharmacy systems and platforms have you used?
   Examples: Caremark, RxClaim, Facets, GuidingCare, etc.
7. What volume of prior authorization reviews did you complete daily in your most recent role?
8. Have you communicated PA determinations directly with physicians, providers, or members? Please explain.
9. Do you have a private workspace in your home with a door?
10. Can you attend training from November 9, 2026 – December 4, 2026, Monday–Friday, 8:00 AM–4:30 PM CST, and work the assigned schedule following training?
    Yes / No

Important Dates

Last Offer Date: October 12, 2026
Last Acceptance Date: October 15, 2026
Candidate MUST Clear Prior To: October 30, 2026

Class Start Date: November 9, 2026