Clinical Services Representative, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Not provided

Salary:

17.00 - 28.46 USD / Hour

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Job Description:

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.

Job Responsibility:

Take in-bound calls from providers, pharmacies, and members etc, providing professional and courteous phone assistance to all callers through the criteria based prior authorization process
Maintain complete, timely and accurate documentation of reviews
Transfer all clinical questions, escalations and judgement calls to the pharmacist team
Assist with other duties as needed to include but not limited to: outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team

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
Must be able to utilize available resources independently and provide high quality work
Must be able to absorb presented information, display motivation, seek development and problem solve
Ability to adapt and change with workflow and shifting priorities
Must possess excellent written, verbal, grammar, and listening communication skills
Must be able 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 (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and 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:
August 07, 2025

Expiration:
August 25, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Clinical Services Representative