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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Clinical Pharmacist- Prior Authorization (Medicaid)

Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix, TX-Houston
This role is office based in Phoenix, AZ or Houston, TX
Applicants must be comfortable working an 8 hour shift within the time frame of 7am-7pm.

Performs prospective and/or retrospective drug utilization review. Coordinates the distribution of clinical drug information and educates providers and staff regarding the appropriate use of pharmaceutical treatment regimens.

Fundamental Components:
Improves quality of service to members by providing prior-authorization of formulary drugs, developing programs to provide optimal pharmacy care to patients, participating in dispute resolution of drug utilization review, measuring and documenting improvements in patient care, and/or improving claim adjudication for proper provider reimbursement. Collaborates with other medical personnel in developing treatment guidelines and demonstrates the impact of these guidelines. May participate in formulary development and management. Monitors prescribing habits of participating physicians. Makes recommendations to physicians to improve medication regimens as appropriate. Maintains the non-formulary exception program and/or the rebate program consistent with contract, state and/or federal guidelines. May audit providers to ensure accurate dispensing and billing of products. Collaborates with the pharmaceutical community to ensure timely payment is maintained. May support the drug rebate regulations and mandates by maintaining pharmaceutical reimbursement methodology for multisource products. Validates the clinical availability of multisource products for provider utilization. May assist the client with rebate reporting requirements. Supports the Pharmacy and Therapeutics Committee function. May develop and maintain a newsletter for provider staff, promoting rational prescribing habits. Performs other duties as required.

Background Experience:
-Current unrestricted state pharmacist license required for Texas or Arizona
-Kansas pharmacist license preferred
-1+ year of pharmacist experience required
-Managed care experience preferred
-Understanding of medical and pharmacy terminology required
-Knowledge of clinical program components, formulary designs, and prescription benefit trends preferred

Pharmacy - Licensed Pharmacist, Pharmacy - Registered Pharmacist

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)


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