Full-Time

Clinical Pharmacist Operations Advisor

Aetna Medical Prior Authorizations

Posted on 8/18/2026

Deadline 8/23/26
CVS Health

CVS Health

10,001+ employees

Healthcare, insurance, PBM, and retail pharmacy

Compensation Overview

$50.48 - $84.62/hr

+ Bonus + Commission + Short-term incentive

Company Historically Provides H1B Sponsorship

Florida, USA

Remote

Must work 8am–7pm Central Time; rotating weekends and occasional holidays may be required.

Bachelor's, PharmD

Category
Medical, Clinical & Veterinary (1)
Required Skills
Microsoft Office
Salesforce

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Requirements
  • An active pharmacist license in the state of residence in good standing is required.
  • At least 2 years of clinical pharmacist experience is required.
  • At least 1 year of demonstrated experience issuing clinical determinations within prior authorizations is required.
  • Current experience working within the Novologix system, specifically Aetna Medical Prior Authorization Operations, is required.
  • Current experience issuing clinical determinations within Aetna Medical Prior Authorization is required.
  • A Bachelor of Pharmacy or Doctor of Pharmacy degree is required.
Responsibilities
  • Conduct reviews of medical data to perform prior authorization reviews for specialty medications.
  • Apply clinical knowledge to planned approved criteria for prospective and concurrent case reviews.
  • Use CVS Caremark-supported systems.
  • Take inbound calls from physicians or members regarding pending, approved, or denied prior authorizations.
  • Follow all prior authorization procedures to ensure a timely and accurate process for each prior authorization.
  • Effectively prioritize work while maintaining a high level of urgency for calls and assignments.
  • Communicate with pharmacists, clinical colleagues, healthcare professionals, and members.
  • Train and mentor representatives on the prior authorization team.
Desired Qualifications
  • Excellent interpersonal skills.
  • Problem-solving ability and attention to detail.
  • Ability to work effectively in a team environment with dependability.
  • Excellent oral and written communication skills.
  • Ability to quickly assess and adapt to constantly changing situations.
  • High mental agility and alertness.
  • Call center, pharmacy benefit manager, or clinical experience.
  • Strong Microsoft Office skills.
  • Experience using CAS, Novologix, Salesforce, RxClaim, and PeopleSafe.

CVS Health operates as a diversified health services company in the United States, organized into Health Care Benefits, Pharmacy & Consumer Wellness, and Health Services. Its offerings include medical insurance products, retail and mail-order prescription drugs, and pharmacy benefit management (PBM) services, all connected through its integrated platform. By combining insurance, retail pharmacy, PBM, and health solutions, CVS Health coordinates care and controls costs across touchpoints for individuals, employers, and government programs. The company aims to lower health care costs while improving access and health outcomes for customers.

Company Size

10,001+

Company Stage

IPO

Headquarters

Woonsocket, Rhode Island

Founded

1963

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Simplify Jobs

Simplify's Take

What believers are saying

  • CVS raised 2026 adjusted EPS guidance to $7.90-$8.10 on August 5, 2026.
  • CVS and Eli Lilly launch Zepbound and Foundayo pricing in-app by early Q4 2026.
  • CVS opened pharmacy-focused Houston stores and plans nearly 20 nationwide openings.

What critics are saying

  • Reuters said Caremark expects weaker client retention after August 5, 2026 results.
  • Louisiana settled three PBM lawsuits with CVS for $45 million on February 20, 2026.
  • Tennessee's FAIR Rx Act threatens 137 CVS pharmacies and MinuteClinics, risking forced divestiture.

What makes CVS Health unique

  • CVS integrates Aetna, Caremark, and 9,000 pharmacies across U.S. scale.
  • August 5, 2026 results showed all three segments beat revenue expectations.
  • Teresa Heitsenrether joins the board November 18, 2026, signaling data-driven healthcare execution.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Company News

Yahoo Finance
Aug 19th, 2026
CVS Health appoints JPMorgan data executive to board as focus shifts to digital healthcare

CVS Health has appointed Teresa Heitsenrether, a senior executive from JPMorgan Chase with extensive data and analytics experience, to its board of directors. The move follows the resignation of board member Larry M. Robbins. The appointment signals CVS Health's focus on technology and data-driven healthcare at the governance level. The company, valued at approximately $120bn, operates an integrated healthcare model spanning insurance, pharmacy benefits, and retail services. Heitsenrether's data expertise aligns with CVS Health's strategy to leverage digital capabilities and operational efficiency across its businesses, including Aetna and Caremark. The company faces challenges including high debt levels and reimbursement pressures in a competitive market alongside UnitedHealth Group and Cigna.

Yahoo Finance
Aug 14th, 2026
CVS Health beats Q2 revenue and profit estimates but faces questions on sustainability

CVS Health reported second quarter revenue of $106.1 billion, beating analyst estimates of $99.41 billion by 6.7%. Adjusted earnings per share came in at $2.58, surpassing expectations of $1.85 by 39.4%. Management attributed strong performance to specialty pharmacy and Medicare Advantage, with CEO David Joyner noting improvements from actions taken in Aetna and Caremark. The company raised its full-year adjusted EPS guidance to $8 at the midpoint. However, analysts raised concerns about sustainability. Management acknowledged ongoing challenges in the 340B program and normalisation of script share gains from Rite Aid. To offset these headwinds, executives pointed to biosimilars and investments in service technology. The company has committed $20 billion over a decade to AI and technology investments, with operational savings already being realised.

Fox Business
Aug 13th, 2026
Nine major PBMs to display TrumpRx prescription drug prices from 2027

Nine pharmacy benefit managers will integrate TrumpRx prescription drug pricing into their benefit tools, effective 1 January 2027. The Pharmaceutical Care Management Association and participating PBMs—including CVS Health, Express Scripts, Humana, and OptumRx—will display cash prices from TrumpRx alongside plan coverage costs. The agreement covers commercial, Medicare, and Medicaid plans. Patients will see TrumpRx prices for all listed drugs, whether through presidential deals or standard pricing. CMS Administrator Dr Mehmet Oz said the commitment will help patients compare prices and find better deals. PCMA CEO David Marin stated the transparency will allow consumers to make better-informed choices about prescription drug costs. Some PBMs will use Real Time Benefit Tools to display pricing comparisons, whilst others may employ different methods.

Yahoo Finance
Aug 11th, 2026
AbbVie acquires Apogee Therapeutics for $10.9B amid pipeline expansion

AbbVie has announced a $10.9 billion acquisition of Apogee Therapeutics in June 2026, aiming to strengthen its drug pipeline. The biopharmaceutical company reported FY 2025 revenue of nearly $61.2 billion, up roughly 8.6% year-on-year. Net income reached close to $4.2 billion, reflecting a net margin of approximately 6.9%, down from 7.6% the previous year. Free cash flow for the period was nearly $17.8 billion. CVS Health reported FY 2025 revenue of approximately $402.1 billion, representing growth of nearly 7.8%. The integrated healthcare provider serves around 37 million medical members and manages 1.9 billion prescriptions annually through its Health Services segment. Net income was close to $1.8 billion, yielding a net margin of roughly 0.4%, down from 1.2% in FY 2024.

Yahoo Finance
Aug 5th, 2026
CVS Health Q2 earnings beat expectations, partners with Eli Lilly on weight loss drugs

CVS Health reported second-quarter net income of $2.98 billion, or $2.31 per share, significantly beating analyst expectations of $1.85 per share. Revenue rose 7% to $106.10 billion, surpassing the forecast of $100.11 billion. The company raised its full-year adjusted earnings guidance to between $7.90 and $8.10 per share, up from $7.30 to $7.50 per share. Revenue guidance increased to at least $414 billion from $405 billion. CVS announced a partnership with Eli Lilly, with the CVS Health app to display pricing for Lilly's weight loss drugs Zepbound and Foundayo starting in early fourth quarter 2026. The company also reduced MinuteClinic virtual weight loss consultations to $29, eliminating membership fees.