• Serve as a pharmacy domain expert in enterprise sales meetings, supporting complex deals with large health systems and pharmacy organizations. • Lead or support conversations focused on 340B operations and/or intake and prior authorization workflow. • Provide value and partnership with pharmacy executives by speaking fluently about operational realities, regulatory considerations, and workflow pain points. • Collaborate with Sales to shape deal strategy, respond to detailed pharmacy-specific questions, and support late-stage deal acceleration. • Partner with our SVP Pharmacy on strategy and prioritization of new offerings and solutions

• Complete remote order entry, order verification, and drug verification. • Provide patient counseling when needed. • Navigate multiple pharmacy information systems (PIS). • Provide drug information and therapeutic guidance to providers. • Assess medication appropriateness, dosing (including renal/hepatic adjustments), interactions, and compatibilities. • Support specialized populations such as pediatrics, geriatrics, pregnant/nursing patients, and those with renal/hepatic impairment. • Maintain knowledge of IV therapies, cardiac/narcotic drips, IV antibiotics, and more. • Document interventions and clinical actions accurately and promptly. • Communicate effectively with physicians, nurses, and patients. • Ensure compliance with HIPAA, pharmacy laws, and client policies. • Work across VPNs, automation systems, and multiple PIS platforms. • Use applications such as Google Suite/Microsoft Office and Snagit. • Maintain required licenses, credentials, and system access. • Participate in ongoing training (clinical, PIS, and policy updates). • Meet productivity and quality standards.

• Lead negotiation of specialty pharmacy participation agreements across all provider segments, including national chains with specialty capabilities, independent specialty pharmacies, and health system–affiliated providers. • Own reimbursement structures, contract terms, and financial outcomes for specialty pharmacy agreements, including high-cost drug categories. • Establish negotiation strategies that balance market competitiveness, provider sustainability, and enterprise financial objectives within the specialty drug landscape. • Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions. • Approve contract exceptions and ensure alignment to broader specialty network and enterprise strategy. • Provide strategic leadership over specialty pharmacy participation agreements, network addenda, and contract standards, ensuring consistency with enterprise pricing, access, and compliance objectives. • Develop and maintain contracting playbooks, standards, and governance frameworks to support scalable and consistent negotiation practices. • Guide contract structure decisions to support evolving pricing strategies, regulatory changes, and market dynamics. • Recommend enhancements to contract language and structure to improve clarity, enforceability, and long-term sustainability. • Lead specialty provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability.

Role Description The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members, etc., providing professional and courteous phone assistance to all callers through the criteria-based prior authorization process. Maintains complete, timely, and accurate documentation of reviews and transfers all clinical questions, escalations, and judgment calls to the pharmacist team. The Tech I will also assist with other duties as needed, including but not limited to: - Outbound calls - Reviewing and processing Prior Auths received via fax and ePA - Monitoring and responding to inquiries via department mailboxes - Other duties as assigned by the leadership team Additional responsibilities include: - Entering prior authorization requests submitted by healthcare providers, ensuring all required documentation is complete and accurate - Verifying insurance coverage to determine if prior authorization is required for specific medical procedures, treatments, or medications - Inspecting medical records and clinical documentation to assess the medical necessity and appropriateness of the requested services or treatments - Assisting in the preparation and submission of appeals for denied or rejected prior authorization requests, including gathering necessary supporting documentation - Documenting relevant information into electronic systems, including patient details, medical codes, and prior authorization status - Communicating with team members and supervisors to identify process inefficiencies and propose solutions to streamline prior authorization operations - Communicating with healthcare providers to obtain additional information, clarify documentation, and communicate prior authorization decisions or requirements - Maintaining awareness of updated industry regulations, medical coding guidelines, and changes in prior authorization requirements by participating in training sessions and knowledge-sharing activities - Ensuring adherence to regulatory guidelines, company policies, and industry standards during the prior authorization process Qualifications - 6 plus months of Customer Service/Pharmacy Technician Experience - Able to apply basic computer skills - Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable - Keyboard skills essential - Regular and predictable attendance - Colleague will be required to work mandatory overtime/extended work week when needed - Colleague will be required to travel when needed - Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards - Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers Preferred Qualifications - Must be able to multitask and utilize multiple system applications simultaneously - Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols - 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) 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 This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include: - Medical, dental, and vision coverage - Paid time off - Retirement savings options - Wellness programs - Other resources, based on eligibility Additional details about available benefits are provided during the application process and on Benefits Moments. Application Window We anticipate the application window for this opening will close on: 06/19/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.