Virtual Pharmacy Technician - Coverage Determination Specialist
Company: CVS Health
Location: United States
Employment Type: FULL_TIME, PART_TIME
Date Posted: 2025-11-07
Valid Through: 2026-11-07
Job Summary
CVS Health is seeking a dedicated and detail-oriented Virtual Pharmacy Technician - Coverage Determination Specialist to join our dynamic remote pharmacy operations team. In this role, you will be responsible for evaluating and processing coverage determination requests for prescription medications under health plan benefit guidelines. You will work closely with pharmacists, healthcare providers, and insurance representatives to ensure accurate, timely, and compliant adjudication of coverage decisions while maintaining the highest standards of patient care and data integrity.
This is an excellent opportunity for individuals with strong pharmacy knowledge, analytical skills, and a passion for helping patients access the medications they need through a remote, technology-driven environment.
Key Responsibilities
Review, evaluate, and process coverage determination requests submitted by prescribers, members, and healthcare providers.
Interpret clinical criteria, prescription benefit plans, and formulary guidelines to make informed coverage decisions.
Collaborate with pharmacists and medical professionals to ensure accurate decision-making in accordance with regulatory and plan requirements.
Communicate determination outcomes to appropriate stakeholders, maintaining clarity, professionalism, and compliance.
Accurately document all actions taken in internal systems following HIPAA and company confidentiality standards.
Monitor workflow queues to meet productivity and quality benchmarks within established turnaround times.
Identify and escalate complex cases requiring pharmacist review or additional documentation.
Support continuous improvement initiatives within the Coverage Determination department.
Required Skills and Qualifications
Active Pharmacy Technician license (CPhT or equivalent state certification) in good standing.
High school diploma or equivalent; post-secondary education in a related field preferred.
Proficient knowledge of pharmacy terminology, medication names, and insurance processes.
Excellent communication and documentation skills, both written and verbal.
Strong attention to detail and accuracy when handling prescription data.
Proficient in using digital pharmacy systems and Microsoft Office applications.
Ability to work independently while collaborating effectively in a virtual team environment.
Experience
Minimum 1–2 years of experience as a Pharmacy Technician, preferably within a managed care or PBM (Pharmacy Benefit Management) setting.
Experience in coverage determination, prior authorization, or pharmacy claims adjudication highly desirable.
Working Hours
Full-time, remote position with flexible scheduling options.
Typical shifts may fall between 8:00 AM – 8:00 PM (local time zone), Monday through Friday.
Occasional weekend or holiday coverage may be required based on business needs.
Knowledge, Skills, and Abilities
Comprehensive understanding of pharmacy benefit management and medication coverage policies.
Ability to interpret clinical data and apply plan criteria to coverage determinations.
Strong organizational and time management skills to handle multiple concurrent cases.
Excellent problem-solving and decision-making abilities under minimal supervision.
Demonstrated commitment to maintaining confidentiality and compliance with HIPAA regulations.
Benefits
Competitive pay structure with performance-based incentives.
Comprehensive health, dental, and vision insurance.
Paid time off (PTO), holidays, and sick leave.
401(k) retirement savings plan with company match.
Employee discounts on CVS products and pharmacy services.
Opportunities for professional growth and certification reimbursement.
Access to wellness programs and virtual health resources.
Why Join CVS Health
At CVS Health, you will be part of a purpose-driven team dedicated to helping people on their path to better health. We empower our employees with meaningful work, cutting-edge technology, and the flexibility of working remotely. You will collaborate with healthcare professionals nationwide to make an impact that truly matters—improving patient outcomes, ensuring access to medications, and shaping the future of pharmacy care.
How to Apply
Interested candidates should visit the CVS Health Careers Portal and search for Virtual Pharmacy Technician - Coverage Determination Specialist.
Submit your updated resume along with any relevant certification details. Shortlisted applicants will be contacted for the next steps in the virtual hiring process.
