[Hiring] Representative I, Clinical Services @CVS Health

Role Description

The Representative I, Clinical Services takes in-bound calls from providers, pharmacies, and members, providing professional and courteous phone assistance to all callers through the criteria-based prior authorization process. Maintains complete, timely, and accurate documentation of reviews. Transfers all clinical questions, escalations, and judgment calls to the pharmacist team.

• Assist with outbound calls
• Review and process Prior Auths received via fax and ePA
• Monitor and respond to inquiries via department mailboxes
• Other duties as assigned by the leadership team

Qualifications

• 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

Requirements

• 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

Education

• High School diploma or equivalent GED

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is: $17.00 - $28.46. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.

Benefits

• 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
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and many other benefits depending on eligibility

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 02/05/2026.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.