Clinical Services Representative, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 28.46 USD / Hour

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Job Description:

Clinical Services Representative taking in-bound calls from providers, pharmacies, and members, providing professional and courteous phone assistance through the criteria based prior authorization process while maintaining complete documentation of reviews.

Job Responsibility:

Take in-bound calls from providers, pharmacies, and members
Provide professional and courteous phone assistance to all callers through the criteria based prior authorization process
Maintain complete, timely and accurate documentation of reviews
Transfer clinical questions, escalations and judgement calls to the pharmacist team
Assist with outbound calls
Review and process Prior Auth's received via fax and ePA
Monitor and respond to inquiries via department mailboxes

Requirements:

Ability to apply basic computer skills
Knowledge of Microsoft Office Suite: Excel and Word required
Access, Outlook, PowerPoint, Visio preferable
Keyboard skills are essential
Must be able to multitask and utilize multiple system applications simultaneously
Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols

Nice to have:

Prior authorization experience
Utilize available resources independently and provide high quality work
Absorb presented information, display motivation, seek development and problem solve
Ability to adapt and change with workflow and shifting priorities
Excellent written, verbal, grammar, and listening communication skills
Ability to deal with a diverse customer base (internal and external) in a friendly and confident manner
Ability to maintain confidentiality of PHI (Protected Healthcare Information)
Associate Degree or Bachelor's Degree

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 20, 2025

Expiration:
September 26, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Clinical Services Representative