Pharmacist – Clinical Operations Advisor
| Company | CVS Health |
|---|---|
| Location | Kansas, USA, Pennsylvania, USA, Delaware, USA, Iowa, USA, Vermont, USA, Texas, USA, Jackson Township, NJ, USA, Florida, USA, Waterbury, CT, USA, South Carolina, USA, Georgia, USA, Concord, NH, USA, Tennessee, USA, Arkansas, USA, Minnesota, USA, Nebraska, USA, Rhode Island, USA, Kentucky, USA, New York, NY, USA, Maryland, USA, Wisconsin, USA, Maine, USA, Massachusetts, USA, North Carolina, USA, Oklahoma, USA, Missouri, USA, Ohio, USA, Indiana, USA, Louisiana, USA, Michigan, USA, Illinois, USA |
| Salary | $110925 – $249600 |
| Type | Full-Time |
| Degrees | PharmD |
| Experience Level | Junior, Mid Level |
Requirements
- Active Registered Pharmacist license in state of residence
- 2-3+ years prior relevant work experience as a pharmacist in managed care (Pharmacy Benefit Management) environment
- Demonstrated understanding of CVSH clinical portfolio, marketplace segments dynamics (Medicare, Medicaid, Exchange, and or Commercial) and industry trends
- Demonstrated experience with Utilization Management and Formulary Management in managed care environment
- Proficiency with Microsoft applications – Excel, PowerPoint, Word, Outlook, Access, Teams
- Demonstrated experience with CVSH internal reporting and analytic tools for client management or industry equivalent
- Excellent written and verbal communication skills both virtually and in person
- Ability to analyze large volume of clinical data and organize this data for downstream teams such as configuration and testing teams
- Attention to detail to ensure data fidelity and data integrity is well understood including the business rules for data transformation
- Ability to work on multiple projects, prioritize, and resolve complex problems
- Effectively work independently without daily supervision
- Impact and influence others
- Drive results and deliver on goals and commitments
- Facilitate cross functional communication and collaboration
- Consult and influence internal stakeholders and client contacts
Responsibilities
- Collaborates with Health Plan Clinical Advisor to understand the client’s clinical strategy and roadmap to create a clinical operations plan
- Works with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements and designs the drug level setup for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines
- Designs the clinical setups using Caremark technology solutions and supports the coding teams in the loading of clinical data into the adjudication system
- Partners with account team members to document clinical design best practices, provide input to streamline processes, and identify opportunities to improve the efficiency and accuracy of clinical setups
- Supports internal and client audits of clinical setups within adjudication systems, which includes verifying the client approved requirements and design
- Manages multiple health plan clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial
Preferred Qualifications
- Experience supporting Pharmacy Benefit Management (PBM) clients or within a health plan
- Experience in all market segments (Medicare, Medicaid, Exchange and Commercial)
- Expertise in Utilization Management, Formulary Management and Clinical Products
- Experience implementing template and/or customized clinical programs
- Knowledge of PBM adjudication engine and other systems leveraged in support of clients
- RxClaim experience
- Proven leadership skills
- Commitment to client service and relationship building