Clinical Advisor - Academic Detailer

CVS Health

4d•Remote

About The Position

The Academic Detailer/Clinical Advisor is a unique and high-impact pharmacist role combining clinical expertise, Medicare knowledge, data insights, and provider-facing communication skills. In this role, you will partner directly with a Medicare Advantage Health Plan to optimize formulary utilization, guide providers through preferred product selection, and support members in receiving the safest, most cost-effective therapies. You will serve as a front-line clinical expert—educating prescribers, influencing prescribing behavior, identifying cost and quality opportunities, and ensuring the drug benefit is delivered in a clinically sound and financially responsible manner. This includes leveraging data, engaging directly with physicians, and aligning PBM and health plan strategies to drive superior outcomes. This role is ideal for a pharmacist with PBM or health plan experience, strong knowledge of Medicare Part D rules, and exceptional communication and analytical skills. This is a remote role, open to qualified candidates within the United States. Candidate must be willing and able to travel up to 40% of the time to meet business needs.

Requirements

Active, unrestricted pharmacist licensure
5+ years of clinical experience, ideally including at least 1 year in a PBM, Health Plan, or Managed Care residency program.
Strong demonstrated understanding of Medicare Part D benefit design, UM criteria, coverage determinations, and formulary management.
Exceptional oral, written, and interpersonal communication skills.
Proficiency in Microsoft tools and comfort working with data, dashboards, and reporting systems.
Ability to travel up to 40% for provider engagement and onsite Health Plan needs.
BS in Pharmacy or PharmD

Nice To Haves

3+ years direct experience in PBM, Health Plan, or Managed Care pharmacy in a client-facing role.
Experience influencing prescribers, conducting academic detailing, or leading provider education initiatives.
Strong analytical skills with ability to explain net cost, rebates, preferred product strategy, and clinical impact in simple terms.
Ability to manage multiple high-visibility projects simultaneously and work autonomously.
Familiarity with AMCP frameworks; AMCP Fundamentals of Managed Care Pharmacy Certificate strongly preferred.
Comfort preparing provider-facing materials, clinical talking points, or formulary change communications.

Responsibilities

Serve as the clinical subject matter expert for Medicare Part D formulary, utilization management, and preferred product strategy.
Analyze drug utilization, trends, prescriber behavior, and savings opportunities at the plan, provider, and member level.
Identify and implement strategies to drive preferred product adoption, biosimilar conversion, generic utilization, and gross-to-net optimization.
Translate complex rebate, pricing, and utilization concepts into clear recommendations for both providers and health plan partners.
Conduct direct outreach to prescribers via phone, virtual sessions, and in-person visits to influence safe, cost-effective prescribing.
Deliver concise clinical messages on preferred alternatives, formulary pathways, safety considerations, and affordability.
Educate providers on coverage determination processes, PA submissions, documentation requirements, and Medicare rules.
Build strong relationships with prescribers, provider groups, and health plan clinical teams to reduce avoidable denials and improve member experience.
Apply expert-level understanding of CMS guidelines, HPMS memos transition rules, tiering exceptions, and benefit requirements.
Support providers in navigating Coverage Determinations (CDs), Prior Authorizations (PAs), redeterminations, and appeals.
Assist in the identification and correction of common PA submission patterns that lead to denials.
Partner with analytics teams to develop and deliver monthly, quarterly, and annual clinical reporting for the Health Plan.
Use internal reporting tools (e.g., analytics dashboards, claims systems) to produce actionable insights.
Present clinical and financial outcomes to health plan and PBM leadership, showcasing progress and impact.
Work closely with PBM stakeholders, health plan pharmacy leadership, FWA teams, formulary operations, specialty teams, and network partners.
Identify opportunities to reduce fraud, waste, and abuse and improve overall drug program performance.
Participate in strategy meetings, benefit reviews, provider initiatives, and clinical program deployment.
Represent Caremark and the Health Plan in provider meetings, care team discussions, and cross-functional initiatives.
Support implementation of new clinical programs, benefit changes, and formulary updates.
Travel for onsite provider visits, health plan meetings, and targeted field engagement as required (up to 40%).